LIBRARY OF CONGRESS. 



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- ^RlL 

UNITED STATES OF AMERICA. 



CHOLERA 



AND 



ITS PREVENTIVE AND CURATIVE 
TREATMENT. 



By 
D. K RAY, M.D ., L.S.A. (Lokdon), 

Attending Physician to the Dispensary of the New York Homoeopathic 
Medical College, and to Wilson Mission Dispensary, Neiv York. 






WITH AN INTRODUCTION 

By T. F. ALLEN, A.M., M.D., 



Professor of Materia Medico, and Therapeutics in the Neiv York Homoeo- 
pathic Medical College, President elect of the American Institute 
of Homoeopathy, etc., etc. 






>6o8 



NEW YORK: 

A. L. CHATTERTON PUBLISHING COMPANY, 

No. 166 Greenwich Street. 

1884. 






Copyrighted 1884, by 
D. N. Ray, M. I). 




The Chas. M. Green Printing Co.j 

74 AND 76 BEEKMAN STREET, 
NEW YORK. 



IN CONSIDERATION OF 
FRATERNAL LOVE AND RESPECT THIS LITTLE WORK 

3£s @LfUttionuUl$ fietrtcatetr 

TO 

P. K. rA.Y, D. Sc. (London and Edinburgh), 

BY HIS YOUNGER BROTHER, 



PREFACE. 



I began to collect the materials for this work on 
" Cholera and its Preventive and Curative Treatment" 
during my residence in India, my native country, 
where, especially in Bengal, the dreaded pest is never 
absent. It is needless to state here how virulent is 
its nature and how destructive its effect when once it 
obtains a footing ; the average mortality ranging from 
twenty-five to eighty per cent. America has also suf- 
fered somewhat at long intervals, and its appearance at 
the present time in different European countries has 
given just cause to fear that it may again make its ap- 
pearance here. Statistics show the probability of this 
visitation, for, in the past, whenever it has raged on 
the European coast it has usually found its way across 
the ocean, defying nearly all precautionary measures. 
We read in every day's paper accounts of its ravages, 
and that it is spreading fast. I therefore consider that 
this is the proper time to make public the result of 
my observation and experience. If it shall be of any 
use to the profession or the public, I shall feel myself 
amply repaid for the trouble it has cost me — which is 
more than my readers may know, for the reason that 



6 PREFACE. 

I have been compelled to express myself in a language 
other than my own. 

I take this occasion to extend to Professors S. P. 
Burdick and S. Lilienthal my grateful acknowledg- 
ment for many courtesies extended to me, both in con- 
nection with this little work and otherwise. 

My obligations to Professor Malcolm Leal call for 
my strongest acknowledgment. My best wishes in 
all things will attend him always, and his friendship T 
shall retain as one of the pleasantest reminiscences of 
my sojourn in this city. 

Professor Allen, to whom I am indebted for the ac- 
companying Introduction, as well as other evidences of 
kindness, is entitled to and will forever have my warm- 
est friendship and esteem. 

My inclination leads me to name many other friends 
and acquaintances whose considerate treatment and 
kindness have made pleasant and profitable my stay in 
this city. To each of them I extend my thanks. 



DWAEKA NATH EAY. 



New York, 131 East 27th St., 
July, 1884. 



CONTENTS. 



I. Synonyms 11 

II. Definition 11 

III. History 12 

Different epidemics 18 

IV. Etiology 19 

Theories : 

1. Blood-poisoning theory of Dr. Johnson 21 

Objections to the theory 22 

2. Drinking-water theory of Drs. Bayer and J. Sdow. 24 

3. Fungus theory of Drs. W. Budd, Farr, and 

several others 24 

4. Damp-subsoil theory of Professor Pattenkofer 26 

Objections to the theory 27 

5. Dr. Bryden's theory 28 

6. Dr. Pacini's theory 29 

" 7. The vibrionic theory of Dr. Macnamara 30 

8. The bacillus theory of Dr. Koch and his colleagues. 31 

V. The Modes of Propagation 34 

VI. The Predisposing Circumstances 35 

VII. The Exciting Causes 37 

VIII. Symptoms 38 

1. First stage, or the stage of invasion 38 

2. Second stage, or the stage of development or 

evacuation < 39 

3. Third stage, or the stage of collapse or algide stage. 42 

4. Fourth stage, or the stage of reaction 44 

IX. Complications and Sequelae , 46 

1. Relapse 47 

2. Imperfect reaction 47 

3. Typhoid state of cholera , . 47 



8 CONTENTS. 

4. Uraemia 48 

5. Ulceration of the cornea 49 

6. Certain rarer forms of complications, gangrene, 

bed-sores, ulcers, etc 50 

X. Diagnosis 51 

XI. Prognosis 52 

XII. Morbid Anatomy 54 

(a) First and most common in the stage of collapse. . 54 

(b) Second, or in the stage of reaction 60 

XIII. (a) The Condition of the Blood 62 

(by The Condition of the Secretions 65 

(1) Saliva 65 

(2) Consideration of the evacuation, or intes- 

tinal secretions 65 

(3) Bile 69 

(4) Urine . . . , 69 

XIV. Treatment 70 

a. Preventive or prophylactic treatment 71 

b. Curative treatment 76 

1. By purgatives 76 

2. Venesection 77 

3. Charcoal 77 

4. Transfusion or injections 77 

5. A short allopathic treatment 78 

A table showing the comparative view of the 

various modes of treatment 81 

6. Comparative view of the homoeopathic and 

allopathic treatments 84 

7. Homoeopathic treatment 84 

a. Selection of a room, etc 86 

b. Medicinal prophylactic treatment 88 

c. Medicinal curative treatment 89 

XV. (a) Diet 122 

(b) Some of the Methods of preparing Foods 

for Convalescents 123 

(c) A Short Table showing the Death per cent 

under Homoeopathic Treatment 126 



INTRODUCTION. 



My good friend and former pupil, Dr. Dwarka 
Nath Ray has asked me to introduce his work to the 
public, which I am the more willing to do as his 
labor has been largely under my own eye and partly 
in my library, and I can vouch for his fidelity and 
zeal. It seems peculiarly fit that a native of India 
should undertake a work on Cholera, and in this in- 
stance, prepared as it is by one of high caste in his own 
country, educated also in England and in America, 
there is every reason to believe that it will command 
the respect of his countrymen, as well as of his co- 
laborers the world over. 

T. F. ALLEN. 



CHOLERA 

AND 

ITS PREVENTIVE AND CURATIVE TREATMENT. 



I. Synonyms. 



In the nomenclature of diseases the following 
names occur for cholera : Asiatic Cholera ; Serous 
Cholera ; Spasmodic Cholera ; Malignant Cholera ; 
Cholera Asphyxia; Epidemic Cholera; Algide Chol- 
era ; Blue Cholera, or Cholera Morbus. 

II. Definition. 

It is a specific epidemic or endemic disease, espe- 
cially the former, characterized by the development of 
the following symptoms : The patient at first com- 
plains of a feeling of uneasiness, which is soon after 
followed by nausea ; a feeling of oppression or pain at 
the pit of the stomach ; constant vomiting ; frequent 
watery discharges with or without griping pain in the 
abdomen ; scantiness or suppression of urine ; profuse 
perspiration and great prostration ; the hands and 
feet are shrivelled ; eyes are sunk deep in their orbits ; 
the general countenance becomes anxious and aimless ; 
soon follow the cramps and twitching of the muscles 



12 CHOLERA AND ITS TREATMENT. 

in the different parts of the body, especially the limbs ; 
there is difficulty in breathing; the pulse is rapid, 
small, and compressible ; the voice becomes husky and 
sometimes quite suppressed ; the temperature of the 
body begins to fall rapidly ; the extremities are quite 
cold, and the patient passes into a state of collapse. 
The severity of the symptoms differs according to the 
mode of invasion, which is sometimes very rapid and 
at others slow, with symptoms ill-developed. So in 
some cases the disease terminates fatally within six to 
twelve hours, while in others it lasts a little longer ; 
but even in favorable cases the patient suffers a good 
deal. 

III. History. 

It would be idle to attempt to state the exact date 
when and the place where the disease propagated 
first. But it is pretty certain that it was known to the 
ancients at an early period, for the descriptions of a dis- 
ease of like nature are met with in ancient medical 
works of the Hindus, the Arabians, and the Chinese 
in Asia, as well as in the works of the Greeks and 
Romans in Europe. 

Professor Hirsch reports that Asiatic cholera spread 
over India, Persia, and Constantinople as early as 1031 
a.d. But Dr. Macnamara does not agree with him ; 
he is of the opinion that no description of true Asiatic 
cholera in Europe was known before 1679. Even as 
to this fact there is some doubt and controversy ; this 
so-called cholera was stated by some to be a severe 



HISTORY. 13 

form of dysentery. This is, I believe, most likely 
true, as there is no report of its appearance throughout 
a large extent of country, while on the contrary it had 
been stated that the malady was confined to a limited 
area in London ; hence, as it was not an endemic or 
sporadic disease of this country, it might be well said 
that it was riot an outbreak of true Asiatic cholera, 
so well know T n by its epidemic nature beyond its en- 
demic area. 

But in India the description of the disease in all its 
true character was reported as early as 1503. Succeed- 
ing this period, it seems to me, the disease has broken 
out in an epidemic form in different parts of the 
country, and in some parts it assumed an endemic 
form; it was known as an endemic disease amongst 
the natives of Amboo Valley in Arcot in 1770. Dur- 
ing the period from 1771 to 1783, cholera was preva- 
lent throughout the Travancore country, Ganjam, Cor- 
omandel coast, and Calcutta, and spread northward as 
far as Hurdwar, where, in 1783, it cut off twenty thou- 
sand pilgrims, and extended as far south as Ceylon. 
Since then it has been flourishing all over the country 
with more or less severity. Several cases of true cholera 
were reported here and there in different parts of the 
country during the years from 1809 to 1817. It was 
subsequent to the latter date that the great outbreaks 
occurring simultaneously in different parts of the Old 
Continent drew the minds of people to its closer study 
and investigation. 

A great many superstitions and anecdotes are con- 



14 CHOLERA AND ITS TREATMENT. 

nected with the great cholera epidemic, which first 
broke out somewhere near Jessore, a town in Bengal, 
in August, 1817. This epidemic within three months 
spread throughout the whole province and its vicinity ; 
almost every town in lower Bengal shared its deadly 
poison ; Calcutta, Dacca, Mymensingh, Jessore, and 
Chittagang, etc., were its special victims. But the prov- 
inces beyond, such as Behar and Orissa, were not ex- 
empt from its terrible ravages, for Bhagalpur, Mon- 
ghyr, Purneah, Dinapoor, Belasore, and Cuttack were 
equally affected. The terrible outburst of cholera in 
the camp of the Marquis of Hastings, the then Gov- 
ernor-General at Bundelcund, on the 7th of November 
of the same year, led to the supposition of various con- 
ditions on which depended the morbid poison. I 
would like to devote an entire chapter to the discussion 
of the various theories which have been propounded 
up to the present day. At present I shall trace the 
disease and the manner in which it spread, in the 
course of a few years, over the greater part of the Old 
Continent. Somehow or other cases of cholera were 
reported from different villages and towns of Bengal, 
Bombay, and Madras provinces. This extension from 
one place to another was either due to the direct com- 
munication of people or to a contaminated atmosphere 
which carried the poison ; but whatever might have 
been the means of communication, cholera was preva- 
lent along the eastern and western coasts of India in 
1819. So these places, especially lower Bengal, which 
has been called by Dr. Macpherson the home of chol- 



HISTOKY. 15 

era, have suffered repeated attacks of its outrages peri- 
odically ; so this section of country may be well said to 
be the endemic seat of cholera. It often extended be- 
yond its endemic area. During the year 1820, when 
it was still prevalent on the western coast, the Eng- 
lish Government was compelled to despatch a fleet 
from Bombay to Arabia. Shortly after its arrival at 
Amon, cases of cholera were reported all over, and 
soon similar reports were recorded from Bassora on 
the Persian Gulf, in 1821. Thus through the caravans 
the disease has been carried as far as Astrakhan, beyond 
which, in Russia, no cases have occurred. It is said 
that its further progress had been checked by the pre- 
cautionary measures taken by the Russian Govern- 
ment in anticipation of the evil effect, but what they 
were we could not say ; however, it is true the dis- 
ease did not go further then. 

We must now return to the history of the epidemic 
of 1817, which spread in other directions. During 
the year 1820, soon after the arrival of the British ves- 
sels from India at Bankok, the capital of Siam, this 
country was absolutely devastated by cholera ; it ap- 
peared at the same time in Malacca, Penang, Singapore, 
and Java. In all these places the malady was communi- 
cated by trade. It extended also into China and Russia. 
It first appeared on the shores of the Yellow Sea, rav- 
aged the neighboring province of Ohantung, and then 
turned northward to Pekin, and after crossing the 
Great Wall followed the course of the caravans as far 
as to the Russian Empire. 



16 CHOLERA AND ITS TREATMENT. 

It is also important to trace the disease to the Afri- 
can coast. During the year 1819, cholera spread from 
the south of India into Ceylon ; at that time a vessel 
having some cholera patients on board sailed from 
Tricomalee, on the 9th of October, and on the arrival 
of the ship at Mauritius the disease made its appearance 
among the inhabitants of the latter place, whence it 
was taken to Zanzibar, on the east coast of Africa, in 
1820. 

Succeeding the cholera epidemic (1817-21), it was 
mostly confined to its endemic area, though occasion- 
ally extended beyond the limit. Thus, in 1826, Bom- 
bay Presidency, Sinde, and Panjab were under its 
influence ; during the following year it travelled 
through Cabul and reached Herat and Khiva. On 
the 26th of August, 1829, the disease broke out at 
Orenburg, a frontier town of Russia, through mercan- 
tile transactions, and this was the first place in Europe 
that had been affected by Asiatic cholera. So it pre- 
vailed over many provinces of Russia, as well as the 
neighboring countries, in 1830. 

It now remains for me to trace the continuation of 
this epidemic from India through Europe to America. 
While epidemic cholera was prevalent in Arabia and 
Persia, it advanced northwestward as far as Novgo- 
rod and Moscow, and then made its appearance at 
Constantinople in July, and at St. Petersburg in June, 
1831, continuing its work of destruction during the 
months of July and August. It then marched west- 
ward and reached Vienna and Berlin. So, Hungary, 



HISTORY. 1? 

Bohemia, and Germany suffered from its virulent 
attack. In August, 1831, cholera appeared at Sunder- 
land, though we have no evidence of direct communi- 
cation of the virus from any affected place. Subse- 
quently it appeared at . Newcastle, Gateshead, Edin- 
burgh, and in London. We have already seen that 
cholera failed to spread beyond Germany in 1831, but 
the following year, in March, it burst out in Paris, and 
was communicated to Ireland ; when, after having de- 
populated many of the principal towns, it reappeared 
in England. In 1832 a ship set sail from Dublin with 
patients affected with cholera, and on her arrival at 
Quebec cholera broke out among the inhabitants of 
the city. This was the beginning of the disease in 
America, and occurred in June of the same year. 
From Quebec the disease travelled to New York and 
Philadelphia, and spread over the greater part of 
the United States before the end of the year. 

But the disease still remains un traced to the most 
western part of Europe — that is, Spain and Portugal. 
It has been observed that these countries escaped the 
influence of the epidemic until the } T ear 1833, when a 
merchant-steamer set sail from England on the. 25th 
of December, 1832, and arrived at Oporto after having 
lost several passengers by cholera. This was the cause 
of the outbreak of cholera in Portugal* As to Spain, 
though the Spaniards rigorously enforced the quaran- 
tine,— and so severe was the law that its infringement 
was punishable by death, — in spite of all precautions 
cholera raged with great violence in many of the prov* 
2 



18 . CHOLERA AND ITS TREATMENT. 

inces of Spain in 1833-34. It then assumed its course 
towards the coast of Europe, and visited many of the 
ports, such as Yenicej Trieste, and Naples, as well as 
Rome, in 1836 ; and also many of the islands of the 
Mediterranean, as Malta and Gozo in 1837. 

At this time, also, the eastern shore of Africa was 
under its influence. Most likely the poison was 
communicated from India, particularly from the 
Malabar coast, where the malady had been very se- 
vere in 1833-34, and extended in Africa precisely in 
the same way as in Europe. 

Having traced the extension of cholera all over the 
globe, I give in an abridged form the dates of its oc- 
casional epidemic invasions in different countries : 

In 1840 cholera prevailed in lower Bengal ; in 1840 
(April) in Singapore; in 1842 (August) in China; 
in 1842, Burmah ; in 1843, abated all over ; in 
1844-45, Central India, Cabul, and Persia ; in 1847 
(October), Constantinople. In 1848-49 this epidemic 
was very violent in Austria, Turkey, Russia, Germany, 
and England, and then across the Atlantic in Amer- 
ica (New York, New Orleans, and Canada). So, Dr. 
Macnamara says that this epidemic extended over a 
greater area of land than the epidemic of 1831-32. In 
1850, broke out in Egypt and all over the northern sea- 
port towns of Africa, Mexico, and California; in 1851, 
very much subsided all over ; in 1855-56, from India 
spread to Persia, Arabia, and Africa; in 1860-61, 
Panjab epidemic in India; in 1862, China; in 
1863-66, Bengal, Bombay, Arabia, Africa, Europe 



AETIOLOGY. 19 

(especially Italy, France, Spain, and Portugal), West 
Indies, and America ; in 1871-72, Asia Minor, Austria, 
Hungary. In 1873 the epidemic spread from Calcutta 
to America by voyage, and damaged the latter very 
much. In 1883, the late epidemic of Egypt. 

IY. JEtiology. 

Now comes the question, Did the malady that in- 
fested the whole globe originate in one place and sub- 
sequently spread throughout the world, or did it gene- 
rate de novo in the different localities where it made 
its appearance ? Though there are differences of 
opinion as to this statement, it is pretty certain that it 
originated at first in India, where it raged for a certain 
length of time in an epidemic form before it assumed 
an endemic character. In the other places where it 
appeared from time to time in an epidemic form it 
never assumed an endemic one. 

This distinctly shows that the origin of the disease 
was always connected with some infected area, from 
which favorable circumstances facilitated its rapid 
progress in different directions. It is also evident 
from the history of cholera that there has been com- 
munication between an infected area and a non-in- 
fected before the latter has been subjected to the 
outrages of the malady. But it is not unlikely that 
when once it spread over the whole globe it may have 
selected some suitable soils for its new home, and the 
subsequent attacks take place under the same condi- 
tions as those which give rise to the malady in lower 



20 CHOLERA AtfD ITS TREATMENT. 

Bengal, the supposed home of cholera. I do not see 
any reason why this should not be the case ; so, as 
regards the different epidemics, we are not justified in 
tracing their origin in all cases from their home, 
though Dr. Macnamara has attempted to do so in all 
epidemics that have taken place up to the present 
time, and denies that any special condition of the soil 
or any other circumstances have ever been known to 
originate Asiatic cholera de novo among men removed 
from its endemic influence. Authorities have failed 
to trace in this last epidemic in Egypt any connection 
either directly or indirectly with the endemic area 
(Bengal), and have declared that it must have origi- 
nated somewhere in Egypt- 
Cholera is an acute specific disease. The nature of 
the specific poison is at present quite unknown, 
though various theories have been propounded at dif- 
ferent times to show the true nature of the poison ; 
nevertheless much has been said regarding it, so I 
think it will be better to lay those various theories 
before you. 

The most prominent theories are the following: 

1. Blood-poisoning theory of Dr. G-. Johnson. 

2. Drinking-water theory of Drs. Bayer and J. 
Snow. 

3. Fungus theory of Drs. W. Budd, Farr, and sev- 
eral others. 

4. Damp-subsoil theory of Prof. Pattenkofer. 

5. Dr. Bryden's theory. 

6. Dr. Pacini's theory. 



.ETIOLOGY. 21 

7. The vibrionic theory of Dr. Macnamara, 
S. The bacillus theory of Dr. Koch and his col- 
leagues. 

Now I shall consider each theory by itself, 
1, Blood-jxrisoning Theory of D?\ Johnson. — The 
main theory is that the phenomenon of cholera results 
from the entrance of a morbid poison into the blood, 
either through the lungs or through the gastrointesti- 
nal canal ; that, when in the body, it undergoes rapid 
proliferation and thus destroys the blood-constituents, 
which are then ejected through the alimentary canal. 
His theory is based upon the following facts ; 

(a) Preceding the symptoms of cholera there are 
symptoms of general malaise such as are met with in 
all other diseases which are due to blood-poisoning ; 
in other words, the disease has a period of incubation 
marked by malaise. 

(h) The same view may be inferred from the fact 
of albumen being present in the urine in cholera as in 
diphtheria and other zymotic diseases. 

(c) The copious discharges from the intestines are 
the efforts of nature to eliminate the poison from the 
system and thus to cause recovery, and consequently 
if the secretion be checked the risk of fatal collapse is 
greatly increased. 

(d) In many cases the poison may be inhaled as 
well as swallowed. If this be the case, the blood-poi- 
soning theory is correct as a whole, and the constitu- 
tion must be affected before the development of the 
intestinal symptoms. 



22 CHOLERA AND ITS TREATMENT. 

(e) The specific poison of cholera exercises influence 
on the arterioles of the lungs and causes spasm of the 
muscular coats of these vessels. This leads to the 
imperfect aeration of the blood, and there is pro- 
duced a venous congestion of the right side of the 
heart and therefore systemic poisoning. Relying on 
these facts. Dr. Johnson administered purgatives, such 
as castor-oil, etc., as remedies, which assist the action 
of nature in draining awaj^ the specific poison. 

Objections to the Theory. — With regard to this eli- 
mination theory Mr. J. Simon, one of the greatest of 
the living pathologists, says : " The belief that a primary 
blood-poisoning is the proximate cause of cholera, the 
direct source equally of its intestinal and asphyxial 
manifestation, is, so far as I know, a mere hypothesis. 
It has been much accepted as the only possible ex- 
planation of certain supposed facts, but very question- 
able facts in the natural history of disease, especially 
in explanation of the supposed fact that the utmost 
collapse of cholera may concur with little or no affec- 
tion of the intestinal canal." " The notion of a pri- 
mary blood-poisoning in cholera seems tending more 
and more to be superseded." 

Secondly. Dr. Thudichum has analyzed the blood, 
and says that there is no chemical evidence of the 
presence in the blood of any particular poison. 

Thirdly. The experience of a vast number of prac- 
titioners in India and elsewhere shows that the astrin- 
gent treatment by checking the evacuations affords the 
patient the best chance for recovery. If this be true, 



iETIOLOGY. 23 

as there is no doubt that a vast number of lives are 
saved in cholera by checking the disease in its early 
stages with opium and astringents or with opium or 
sulphuric acid, it is then evident we are acting 
against the blood-poisoning theory. 

Fourthly. Building upon the blood-poisoning theory, 
it has been said that the most fatal cases are those 
in which patients rapidly pass into collapse, or who 
suddenly die without collapse or evacuations. It is 
argued from this circumstance that the poisoning here 
produces such an overwhelming action that the pros- 
tration comes on with great rapidity without first 
producing choleraic discharges, just as prostration may 
be produced in small-pox without any eruption. Two 
points are to be noticed here : (1) It may be a question 
of time ; a patient may have vomited and purged before 
being observed or attended to — that is, there may 
have been rapid vomiting and purging before 
the coming on of the collapse. (2) Very often when 
during life succumb comes on rapidly without any 
discharges, post-mortem examination shows that the 
intestines are soiled with rice-water stools, so that they 
are not evacuated. 

Fifthly. The question of the influence on the arte- 
rioles of the lungs is a mere hypothesis. It is assumed 
to explain certain changes that the lungs undergo from 
the cholera poison. But this may be explained in a 
different manner ; moreover it is difficult to see, if it be 
a poison, why it should affect the arterioles of the lungs 
only and not the other parts of the body. In direct 



24 CHOLERA. AND ITS TREATMENT. 

opposition to this blood-poisoning theory, the state of 
collapse and other similar symptoms in cholera may be 
traced to a draining away of the serum ; the blood, 
thus robbed of its liquid constituents, which cannot 
be restored through the diseased mucous membrane 
of the alimentary canal, becomes thickened, like tar or 
treacle. This state of the blood not only accounts for 
the symptoms mentioned, but impedes the circulation 
and leads to a cessation of life. This was the view 
held by the opponents of this theory. 

2. Drinking-water Theory. — In 1832, during the 
cholera epidemic of 1831-34, M. Bayer, a French- 
man, propounded a theory tracing the disease to a mi- 
asm which was contained in the water of tardy and 
boggy pools. These pools and marshes liberated the 
miasm during the evaporation of water, and thus pro- 
duced the disease. In London, during the epidemic 
of 1848-19, Dr. J. Snow said that the specific poison 
of cholera contained in the stools and vomited matter 
acted directly on the intestinal mucous membrane, 
when swallowed by persons predisposed to the malady, 
in the same way as the poison of small-pox or scarlet 
fever, and then in passing out again with stools into 
water and reaching the alimentary canal of another 
person would give rise to similar conditions. Both 
these observers found drinking-water to be the cause. 

3. Fungus Theory. — This was held by Dr. W. 
Budd, of Bristol, in 1849, as the cause of disease. He 
believed that the disease depended upon a distinct 
species of fungus, which being swallowed, infinitely 



.ETIOLOGY. 25 

multiplied in the intestines, produces symptoms of the 
disease. These living organisms are disseminated by 
contact with food, principally through drinking water 
of the infected places. Here, then, the active poison 
was considered to be a fungus acting on the mucous 
membrane of the intestines, brought there by means 
of drinking-water, and then propagating the disease. 
This theory did not originate with Dr. Budd, for, in 
1839, Boehm, a German observer, described certain 
cryptogamic vegetations in the epithelial debris of 
the choleraic stools. These were micro-fungi ; some of 
them were round, oval, elongated, and others beaded, 
and found in all the vomited matter and ejecta, as 
well as in the intestinal canal. Drs. Thomson, Ilas- 
sels, Swayne, and others accepted the same view, as 
did also Dr. Fan*, in 1S52, the Begistrar-General of 
London, who, in reporting the causes of cholera, said 
that some organic material acting as a zymotic agent 
was developed in the blood, and hence produced the 
morbid condition of the blood. This principle lie 
termed " cholerine." The London College of Physi- 
cians were also of opinion that " the theory that the 
cause of the disease is a general state of atmosphere,'* 
a general "atmospheric influence," or "epidemic con- 
stitution," has been found untenable; they believe 
" that human intercourse has at least a share in the 
propagation of the disease, and that under some cir- 
cumstances it is the most important if not sole means 
of effecting its diffusion ;" " the poison attaching itself 
to the surface of the bodies, to the walls of the rooms, 



26 CHOLERA AND ITS TREATMENT, 

and to the furniture, it will also be collected by the 
clothing of persons living in the infected dwellings, 
will be carried by them from place to place, and wher- 
ever it meets with conditions favorable to its increase 
and action will produce a fresh outbreak of the epi- 
demic." The College, however, observe : u It by no 
means follows that cholera is always propagated in this 
way. It may spread independently of communication 
between the sick and healthy. The agent, then, most 
likely to have conveyed the poison from one spot to 
another is the wind." * 

Now, as regards the fungus theory, it can be well 
said that the careful investigations of Drs. Lewis and 
Cunningham in India have failed to detect any such 
organisms. 

4. Damp-Subsoil Theory. — Professor Pattenkofer, 
of Munich, in 1855, held the theory that (a) the de- 
velopment of cholera depended upon certain conditions 
of the soil. He believed that the subsoil water was 
engaged in the propagation of cholera. With regard 
to the subsoil water, he says that cholera is due to 
the specific organic matter brought into the ground by 
Cholera evacuations — -either stools or vomited matter ; 
(b) that this material in the soil undergoes certain fer- 
mentative changes, so that the evolution of the poison 
is associated with a certain degree of moisture in 
the subsoil. If the subsoil be too dry or too moist, 
then the poison is not produced, but remains dormant 
for any length of time, until appropriate damp sub- 
soil excites its development. The most favorable con- 



AETIOLOGY. 27 

dition for the development of the poison is the clamp 
subsoil — that is, when the water sinks after a previous 
rise; so that the soil is the true nidus, and especially 
when it is sufficiently porous and alluvial to be pene- 
trable by the decomposed excrementitious products. 
When once developed, the poison may be carried in 
various directions, naturally in the direction of the 
water-course of the countiy. The poison required 
air, water, and soil for its fructification. It is possibly 
associated with a certain meteorological condition of the 
atmosphere, and, lastly, certain predisposition with re- 
spect to the individual or patient. Pattenkofer says 
that the poison does not consist of the ejecta of the 
patients, these being innocent with respect to propaga- 
tion ; but it is only when the ejecta pass into the soil, 
and there meeting with appropriate conditions of fer- 
mentation, give rise to the development of the poison. 

With respect to the nature of the poison, Dr. Pat- 
tenkofer denies that impure water or organic matter 
in the subsoil water can develop such poison, but lie 
believes that the ejecta are absolutely necessary. 

Objections to this Theory.— -The objection to this 
theory is that Dr. Pattenkofer said that the best 
time for the development of the poison is wdien 
the subsoil water is sinking. Now it is w T ell known 
that water under such circumstances becomes im- 
pure. Depending on his own hypothesis, it is a 
question, as Virchow asks, whether it is not the im- 
pure water which takes certain part in the propaga- 
tion of the poison ; for the outbreak of cholera, it has 



28 CHOLERA AND ITS TREATMENT. 

been frequently observed, occurs when there is im- 
purity of water. Besides, the theory is based, upon 
the statement that the porous soil is capable of devel- 
oping cholera, whereas statistics show that even in soil 
where the geological formations are altogether differ- 
ent, as in the rocky and granitic soil, such as Bombay 
and Panjab, cholera is developed. The theory is quite 
applicable in Bengal, because here the poison is de- 
voloped in the porous delta of the Ganges ; but such a 
theory would not explain its development in a soil of 
different character. Again, from the record of the 
India Government it would be seen that there is no 
connection with the rise or fall of subsoil water to the 
development of cholera, as it is developed at one time 
with high and at another with low subsoil water. 

5. Dr. Brydenh Theory in 186S. — Dr. Bryclen states 
that the Bengal Presidency may be divided into two 
subdivisions — a lower province, or the area of endemic 
cholera, namely, where cholera is a constant visitor; 
and an upper. In the former the cholera germs lie 
hidden in the ground, and he regards the development 
of cholera as a vital phenomenon, just as the budding 
of a plant ; therefore cholera is developed in lower 
Bengal and is conveyed with the regularity of an epi- 
demic outbreak — that is, with certain periodicity — to 
the upper province. He also mentions that the epi- 
demic period ceases from the first week of October to 
the third week of April, during which time the dis- 
ease is prevalent in the lower province, the upper 
province being entirely free. But after this period. 



AETIOLOGY. 29 

again, from the beginning of May, there are distinct 
systematic periodic visitations in the upper province ; 
moreover, the parts which the disease visits first are 
the environs of the epidemic area, from whence it 
spreads further and further to the northwest and 
northeast. There is, according to him, a specific miasm 
generated which is cholera poison. The most suitable 
vehicle of carriage is the atmosphere when in a cer- 
tain condition. Tims the monsoon carries it from the 
endemic to the epidemic area. Human intercourse, he 
says, is capable of spreading it, but the most common 
way is by the atmospheric diffusion. 

6. Pacini's Theory. — Dr. Pacini, in 1863, first made 
an original inquiry into the causes of cholera. He 
starts (1) with the view that the cholera poison is a 
fungus ; (2) that this fungus acts primarily upon the 
absorbing epithelial lining membrane of the gastro- 
intestinal canal ; (3) that it destroys the epithelium and 
thus converts the absorbing surface into a transuding 
one ; (4) that when this is converted, the flux that 
takes place at the outset of cholera is due to the me. 
chanical process of transudation. Thus when it be- 
comes so severe that the transuding: surface exceeds the 
absorbing one, the recovery becomes almost impossible, 
unless after a time coagulations or thrombi are formed 
in the mesenteric vessels, preventing further transuda- 
tion ; and then the fluid may be absorbed from the 
muscles and other tissues into the blood-vessels, as 
shown by the shrivelled appearance of the body in this 
stage. This is an attempt of nature to produce equi- 



30 CHOLERA AND ITS TREATMENT. 

librium in the system ; and should it not take place, 
the blood, being deprived of its watery constituents, 
becomes so thick that it cannot circulate through 
the capillary blood-vessels ; consequently death en- 
sues. 

7. The Vibrionic Theory of Dr. Macnamara. — 
He holds Pacini's view with certain modifications. He 
says that the poison of cholera is derived from the 
ejecta but not in a fresh state. In order that the poison 
may be developed there, ejecta should undergo cer- 
tain vibrionic stage of decomposition— that is, a decom- 
position in which vibriones may be developed. In 
order that this may take place the ejecta should be 
placed for two or three days at a certain temperature. 
If in this state they are swallowed as Dr. Macnamara 
says, either with food or with drinks (water, milk, etc.), 
then the poisoning will take place and cholera be 
the result. But if the vibriones go beyond this stage, 
they are absolutely harmless; therefore it is only in 
the middle stage that they are poisonous. According 
to him, the material may be dried up for a considerable 
time, but when moisture is again introduced it under- 
goes vibrionic stage of decomposition and produces the 
poison ; when swallowed it produces the same vibrionic 
changes in the mucous membrane of the bowels, and 
alters the epithelial absorbing surface so that it be- 
comes a transuding one, in the same way as Pacini 
has shown ; the result being the outpouring of serum 
through the thin wall of the bowels. The blood is now 
imperfectly aerated and its corpuscles diminished ; the 



.ETIOLOGY. 31 

movement in the capillaries is arrested, and at the same 
time the circulation is impeded by the hydrostatic 
pressure in the vessels. With this the contracting 
power of the heart is diminished, so that the patient 
rapidly sinks and dies; unless, as Pacini has shown, 
nature comes to the rescue by the formation of 
thrombi, when life may be saved by drainage of fluid 
into the vessels from all other tissues. So that Mac- 
namara's views are a short step in advance of Dr. Pacini's, 
inasmuch as he says that the poison consists of organic 
matter in a state of decomposition. He agrees with 
Dr. Farr with regard to the vehicle, and believes with 
Dr. Snow that it is a zymotic principle, and with Dr. 
Pacini in re^ardino; the intestinal mucous membrane 
as the primary seat. So his views are the admixture 
of those of the several other observers. 

8. The Bacillus Theory of Dr. Koch and his Col- 
leagues. — -The bacilli as the origin of cholera have 
created a great sensation in the medical world, and 
all reports on that subject are read with great interest 
by the profession. Dr. Koch and his colleagues, 
who had dissected the dead bodies of nine cholera 
patients in Calcutta, in all cases, with the aid of the 
microscope, discovered the existence of the same 
bacilli as they found in Egypt last year. In their re- 
port of September, 1883, they were unable to decide 
whether these bacilli did not belong to the regular 
parasites of the human gut, and only under the influ- 
ence of the cholera disease had crept into the mucous 
membrane of the intestines. Of late they have de- 



32 CHOLERA A*NTD ITS TREATMENT. 

cided that these bacilli are the origin of cholera. Their 
report goes thus : " There is a lack, then, of sufficient 
symptoms to distinguish these bacilli from others very 
similarly formed. But this want has now, happily, 
been supplied, for with the help of the methods 
devised by the Board of Health, which on this occa- 
sion have proved very serviceable, we succeeded in 
isolating the bacilli from the intestinal contents of the 
purest cholera cases ; and minute observation of these 
bacilli, under our treatment, led to the discovery of 
some very characteristic qualities as to their form and 
growth in gelatine, which enabled us with certainty to 
distinguish them from other bacilli. And now we 
had the means of definitely deciding the question 
whether these bacilli belonged to the regular inhabi- 
tants of the intestine, or whether they occurred exclu- 
sively in that of cholera patients. And first of all, 
with the help of our gelatine preparations, we demon- 
strated the existence of these bacilli in the evacuations 
of all the cholera patients we examined, as well as in 
the intestinal contents of those who had died from 
cholera in a similar manner. We then examined the 
intestines of other corpses, and in every case the 
bacilli in question were absent from the intestine. 
Thus far we have examined the bodies of eight per- 
sons who died of pneumonia, dysentery, phthisis, and 
kidney-disease, as well as of several animals, and other 
substances abounding in bacteria ; but nowhere did we 
find in them anything like our cholera bacilli. Should 
this phenomenon prove constant in the course of the 



AETIOLOGY. 33 

further investigation, a very important result will thus 
have been attained ; for if bacilli of a specific character 
are exclusively incident to the process of cholera, the 
original connection between the appearance of these 
bacteria and the disease would scarcely admit of any 
doubt, even if the reproduction of the disease in 
animals did not succeed. But even in the latter re- 
spect things seem to be in our favor, as some of the 
experiments made on animals have yielded results 
which allow us to hope for further success." 

" The Englishman, of Calcutta, states that Messrs. 
Koch, Fischer, and Gaffky, the members of the com- 
mission sent by the German Government to Egypt 
and India to investigate the origin and causes of 
cholera, have succeeded in discovering the cholera 

germ in a tank of water at Calcutta These 

bacilli have been found in the matter contained in a 
tank used by a suburban village where cholera lately 
appeared, and their connection with the disease thus 
established." 

As to this theory I have not much to say, as it still 
requires further investigation. Professor Koch is de- 
cidedly of opinion that Asiatic cholera is a disease that 
is caused by specific micro-organism (bacilli), and in 
this respect he is completely in accord with Dr. Mac- 
namara, though this gentleman failed to isolate the 
specific germ or to induce cholera in any of the lower 
animals. Dr. Koch, however, believes that he has 
isolated the specific micro-organism of cholera; and 
further, that he has succeeded in holding this parasite 
3 



34 CHOLERA AND ITS TREATMENT. 

in pure cultivation, and in instituting experiments 
with these cultivated organisms on lower animals. We 
hope he will succeed in his further investigation. If 
these bacilli be the origin in the production of cholera, 
there is no doubt that this is a grand discovery, and 
the profession owes a great deal to the discoverers. 
Now we want a germicide for the practical test of the 
discovery. 

All these theories have been brought forward from 
time to time, yet all are open to objection. However, 
it is supposed by all observers that the virus origi- 
nates in the ejecta of an affected person, but how 
it originates and how it acts or what it is we cannot 
dogmatically assert, as it has been found over and over 
that the disease is produced where individuals are not 
exposed to such excrementitious matter, while, on the 
other hand, the disease attacks to a very slight extent 
those persons who are constantly exposed to excreta, 
such as nurses, coolies, and methors who remove the 
ejecta. So, whatever may be the nature of the 
poison, the disease is unquestionably an infectious one, 
has a period of incubation varying fron twenty-four 
hours to two or three days, but seldom longer (in epi- 
demics it varies),, one attack is not a prophylactic for 
a second ; and it runs a definite course, though often 
irregular. 

Y. The Modes of Propagation. 
The disease is capable of being transmitted from one 
person to another, but is not a contagious disease in the 
ordinary sense. This is principally communicated — 



THE PREDISPOSING CIRCUMSTANCES. 35 

(1) By contact, particularly by human intercourse, 
as has been shown in various epidemics : the principal 
means of communication were caravans, pilgrims, voy- 
ages, and trade, etc. 

(2) By atmospheric taint, that is, when the atmos- 
phere becomes so thoroughly contaminated with the 
poison of an infected area that it carried the poi- 
son to a non-infected area ; as the direction of the wind 
or monsoon sometimes shows the course of the epi- 
demic. 

3. By drinks, such as drinking-water, milk, or other 
drinks, principally the first. The poison is drained 
through the soil into the well-water or river-water that 
is used for drinking purposes, and thus enters into the 
system. 

4 By various articles, such as bedding, clothing, 
and other articles that come in contact with the ejecta 
of the cholera patient. 

5. As we are quite ignorant of the nature of the 
poison, we are not able to say how it enters into the 
system ; probably it is either swallowed, inhaled, or ab- 
sorbed by the skin. 

VI. The Predisposing Circumstances. 

1. All ages, including new-born children, and both 
sexes are liable to the disease. 

2. Epidemic constitution is the most common pre- 
disposing cause. 

3. A simple diarrhoea in a patient during an epi- 
demic may develop into a malignant form of cholera. 

4. The individual proclivity. 



36 CHOLERA AND ITS TREATMENT. 

5. Bad hygiene, overcrowding, living in close and 
ill-ventilated rooms, intemperate habits, and drinking 
tainted water, are some of the common predisposing 
causes. 

It is due to the impurity of drinking-water that the 
disease occasionally breaks out twice in a year in those 
districts of Bengal which are subjected to inundation ; 
once with the coming of the flood, when the vegetable 
and other decomposed organic matters make the water 
quite filthy, and again with the decline of the flood, 
when also the drinking-water becomes thoroughly sat- 
urated with organic matter and quite unfit for drink. 

Now, again, the outbreak of cholera due to over- 
crowding and the tolerance of other filthy habits will 
be evident if we refer to the statistics of the great 
fairs {inalilct) that annually take place in Bengal and 
other parts of India. This fair, which lasts for a long 
or short duration, becomes the centre of the disease. 
There people throng together from different quarters 
by hundreds and thousands, and, returning to their 
homes, give rise to several foci. I can say certainly that 
this has been the case for several years in Bengal, not 
a single such occasion being excepted. But now the 
strict observance of the hygienic principles on such 
occasions, under the supervision of the police authority, 
has greatly reduced the mortality ; still I believe that 
the number of deaths from cholera in those fairs much 
exceeds those from any other disease. 

6. The new-comers into an affected locality are 
peculiarly susceptible to the disease. This can be ex- 



EXCITING CAUSES. 37 

plained by the fact that it is more apt to be fatal at 
first outbreak than in the subsequent attacks. 

7. Persons suffering from nervous depression, due 
either to fatigue or debauch, are particularly apt to be 
attacked by cholera. 

8. It is supposed that the development of poison is 
retarded at a temperature below 40° F. or above 212° 
F., but it is most favorable when exposed to the sun 
at 80° or 90° F. 

Too much exhaustion, fatigue, overwork, misery, 
and anxiety, especially during the epidemic, may be 
classed under the predisposing as well as exciting 
causes. 

VII. Excitixg Cattses. 

I have often noticed during cholera epidemics that 
when the disease breaks out in a village there are 
almost invariably certain quarters that suffer more than 
others. So certain sections of a town called in Bengal, 
Bazar, tola or para, become the special centres of 
epidemics, while other sections occasionally almost en- 
tirely escape. There must be some special exciting 
cause in such centres. 

The common exciting causes of cholera are im- 
proper foods, such as decaying vegetables, unripe 
fruits, uncooked or improperly cooked food, decom- 
posed animal diet, especially meat or fish. The latter 
is a very common exciting cause of cholera in certain 
towns or villages of lower Bengal, where, during the 
prevalence of the disease, the poorer class of people, 
who, owing to their humble circumstances, eat putrid 



38 CHOLERA AND ITS TREATMENT. 

fish indiscriminately day after day, are especially sub- 
ject to its attacks. I do not mean to say that this is 
the only exciting cause, but surely upon this depend 
other exciting circumstances common to hovels. Dr. 
Carpenter quotes Dr. Britain as an authority for the 
fact of an outbreak of cholera and choleraic diarrhoea 
among a number of school-children who had eaten 
plentifully of spoiled oysters and contracted the dis- 
ease, by which eleven of the sufferers lost their lives. 

Besides, intemperance in eating or drinking, want of 
proper food or insufficient diet, or anxiety and sleep- 
lessness, may excite the disease. 

VIII. Symptoms. 

The symptoms are usually developed gradually, and 
according to their development the disease may be di- 
vided into stages: first, the stage of invasion ; second, 
the stage of development ; third, the stage of collapse ; 
and fourth, the stage of reaction. 

First Stage.— Previous to the onset of this stage 
there is a period of incubation, varying from twelve 
hours to two or three days, but, as I have said before, 
seldom exceeding this period. There is hardly any 
distinction between this stage and the stage of in- 
vasion; however, this period is characterized by ma- 
laise, soon after which the patient experiences the 
prominent symptoms of the invasion of the disease. 
In a typical case of cholera the following symptoms 
are generally noticed : Following the feeling of ma- 
laise there are general uneasiness, depression of spirits, 



SYMPTOMS. 39 

sense of exhaustion and debility, inaptitude for any 
occupation, anxiety, restlessness, slight oppression in 
the epigastrum, giddiness, ringing in the ears, heavy 
feeling in the head, and often headache. Then grad- 
ually creep the other symptoms, such as relaxation of 
bowels ; this lasts for a few hours or days before the 
actual attack comes on. The stools at this period are 
semi-fluid or sometimes watery, three, four, or more in 
twenty-four hours, accompanied with griping pain in 
the bowels and sometimes heat in the anus. The appe- 
tite becomes dull, tongue clear and moist ; nausea, with 
occasional vomiting, and the patient complains of thirst ; 
sometimes severe vomitings precede the purgings. 

As regards the development of these symptoms there 
is no regularity ; sometimes they appear very quickly, 
and at others very slowly. Sometimes some of them 
are very prominent and persistent, while others are ill- 
developed. During this stage there is nothing very 
characteristic as regards the other systems of the body. 
The duration of the stage of invasion is quite uncer- 
tain and varies greatly in individual cases. It may 
last from a few hours to two or three days, but during 
the epidemics it is often absent. 

Second Stage. — The second stage is known as the 
stage of development or evacuation. There is no regu- 
larity in the passage of the disease from the first stage 
into the second ; sometimes it is very quick, wdiile at 
others gradual. In whatever manner it passes into this 
stage, early morning is considered as a favorable period. 
Copious watery purging is the characteristic sign of 



40 CHOLEEA AND ITS TREATMENT. 

its onset. But in cases where first stage is suppressed, 
the first one or two stools consist of the ordinary con- 
tents of the intestines, or of undigested food mixed 
with large quantity of fluid. The stools are thin, 
watery, pale, slightly opaque, sometimes whitish or 
somewhat milky, containing sediments of minute flaky 
particles of food, alkaline in reaction (specific gravity 
varies from 1005 to 1010), and resemble very much the 
water in which rice has been boiled, and hence called 
the rice-water evacuations. Microscopically, this dis- 
charge consists of abundant granular matter, a few 
epithelial cells, vibrios, bacteria, and Tbioplasm ; chemi- 
cally, mostly water and a considerable quantity of va- 
rious salts, such as soda, potash, and chloride of sodium, 
with albumen and other organic matter. This rice- 
water stool is very characteristic of cholera. Shortly 
after there is frequency of evacuations at short inter- 
vals; with it sometimes diminishes the quantity of 
evacuation, and there may be experienced much pain 
or no pain in the abdomen* The character of the pain 
is very variable ; it is often keen, sharp, and excruciat- 
ing. Repeated vomiting is another most troublesome 
symptom, the attacks being in quick succession, if 
there has been none before. This vomited matter is 
bile-stained water, comes out with considerable force, 
and leaves a foul, bitter taste. The attacks of vomit- 
ing are not so numerous as the purgings; they are 
often excited by the introduction of any articles, as 
medicine or food or drinks. While vomiting and 
purging are continuing the patient feels excessively 



SYMPTOMS: 41 

thirsty, the thirst is unquenchable, and the patient be- 
comes quite exhausted. The general appearance of 
the patient is much altered ; the eyes begin to sink, and 
there are marked dark rings around them, and they 
look staring. At this time the temperature of the 
body begins to fall and sinks to a few degrees below 
normal. With the diminution of bodily warmth the 
external surface of the body, especially the distal parts, 
as the hands, feet, nose, ears, lips, and the tip of the 
tongue, give evidence of coldness, while the rest of the 
body is pretty warm. The voice now gradually loses 
its normal tone, and the patient feels exhausted in 
speaking, but can speak well. The pulse loses its nor* 
mal character, it is small, weak, thready and compressi- 
ble, and may entirely disappear from the wrist for a 
considerable time. One more prominent and distress- 
ing symptom of this stage is cramps. They begin in 
the extremities, frequently in the fingers and toes, and 
gradually travel along the limbs, or may appear simul- 
taneously in the calves of the legs, the thighs and arms ; 
they often occur in the muscles of the abdomen. These 
painful cramps often last until the next stage, if the 
patient does not succumb before it is reached. 

This second stage, in fact, is very perplexing to 
physicians, as it oscillates between good and evil ; at 
one time it gives hope of improvement and recovery, 
at another there seems to be imminent danger of col- 
lapse. This stage, with its stationary period before it 
takes a definite course, lasts a few hours or sometimes 
a full day. 



42 CHOLERA AND ITS TREATMENT. 

Third Stage. — The third stage, the stage of collapse 
or algide stage. If the case does not turn favorably 
and so escape the third stage, which is much more dan- 
gerous than the last, the purging and vomiting of 
the second stage continue. They are much less fre- 
quent and less copious, and their consistency greatly 
varies. The stools may be either a frothy liquid, whit- 
ish or brownish slimy matter, greenish watery liquid, 
or there may be a little clear liquid with gelatinous 
mucous, inodorous at first, but later on becoming very 
offensive. There is intense thirst, the patient is eagerly 
craving drink ; but drinks only relieve the thirst tem- 
porarily, and immediately after the same thirst returns. 
Sometimes there are cramps of greater or less severity. 
When this stage is fully developed the general appear- 
ance of the patient is as follows : the body is quite 
emaciated, the surface livid or pale, and the fingers 
and toes are blue and shrivelled ; the hands and feet 
assume a wrinkled appearance, as if they had been 
soaked in water for a long time. On touch, there is a 
feeling of icy coldness almost all over the body ; the 
external temperature of the body goes clown several 
degrees below normal, sometimes as low as 82° F. in 
the axilla, generally 95°, 96°, or 97° F. The whole 
surface of the body is bathed in a cold, clammy per- 
spiration. This is generally noticed first on the fore- 
head at the root of the hairs, then extends over the 
whole face and also over the chest. The cardiac power 
is greatly diminished, the heart's sounds are scarcely 
distinguishable ; the pulse is absent at the wrists, and 



SYMPTOMS. 43 

in bad cases even imperceptible in the brachial and 
carotid arteries. The eyes are sunk deeply in the or- 
bits and encircled by dark areola, the eyelids are gene- 
rally half open, and the pupils usually contracted, 
though dilated pupils are not uncommon. The lips 
and tongue are cold and dry ; there is a choking sen- 
sation in the throat, with inability to swallow ; the voice 
becomes feeble, hoarse, and husky, sometimes quite 
suppressed. The secretion of urine, which was less in 
quantity and pale in last stage, becomes quite sup- 
pressed now. The patient feels quite restless in his 
bed — in fact, torture in his bed, constantly desires to 
change sides, but feels great exhaustion when doing so; 
in some cases the prostration is so great that the pa- 
tient is unable to change his place in the bed without 
help; sometimes he complains of excessive heat and 
throws off any wrapper or covering from his body as 
if in a frantic fit. Further on comes the critical stage 
when the muscular strength of the patient is either 
very much reduced or, occasionally, so extraordinarily 
increased as to enable him to sit up in bed or run across 
the room. Sometimes, as I have said, the pupils are 
dilated ; the eyeballs move round or are quite steady ; 
the sight becomes dim, so that sometimes the patient 
cannot recognize the neighboring objects. The nose 
and the infra-orbital regions become very prominent, 
and the general appearance death-like. The whole 
body is of a dusky hue, and is covered with a cold and 
clammy perspiration. The respiration becomes labored 
and rapid. There is ringing in the ears and deafness 



44 CH0LEKA AND ITS TREATMENT. 

may supervene. As a rule, in most cases the patients 
do not lose their consciousness. The stools are gelati- 
noid or mucous in consistence and small in quantity, 
half passed in bedclothes and the rest is retained in 
the intestines owing to the inability of the muscular 
coats of the bowels. Thus sometimes there is an ac- 
cumulation of the transuded fluid in the canal, and the 
abdomen thus becomes distended and tympanitic. This 
is entirely due to the partial or complete paralysis of 
the muscular coats of the bowels. The physicians find 
it most difficult to move the bowels in such a state. 
This state seldom lasts more than a few hours, but may 
last twelve to forty hours or even more. When all 
the attendants and relations are anxiously watching, 
the attending physicians have given up almost all hopes 
of recovery, and all the symptoms point towards im- 
mediate death, — even then the case sometimes turns 
favorably and enters the stage of reaction, of which I 
shall speak presently. But in unfavorable cases the 
previously mentioned symptoms become more severe. 
Complete stupor and coma are added, and at last death 
with moaning asphyxia closes the scene. In a great 
majority of cases death thus takes place in this so-called 
cold stage. 

Fourth Stage. — The fourth stage, or the stage of re- 
action. The patient, after having continued in the 
stage of collapse for a shorter or longer period, now 
gives indications of recovery, but he is not yet quite 
out of danger, for complications may arise which 
would soon carry him away. Leaving such cases out 



SYMPTOMS. 45 

of consideration for the present, I shall take up a 
typically favorable case. 

In some cases the recovery is as quick as the decline. 
The physiological secretions soon begin to be restored. 
The urine is secreted at first in small quantity, is 
highly colored, acid in reaction, and has a peculiar 
odor ; albumen may or may not be present. There may 
be sediments present in the urine. The re-establish- 
ment of the excretion of urine is a very hopeful sign, 
and denotes the commencement of the stage of reaction. 
The vomiting and purging may still be present, but 
their frequency is very much diminished. The stools 
become thicker and may be of various colors, but are 
generally yellowish. The pulse becomes perceptible 
at the wrists, and regains its strength. The heart's 
sounds are audible in the precordial region, and assume 
their normal character. The temperature of the body, 
which has been below normal, begins to rise — no par- 
ticular dependence should be placed on the rising of 
the temperature alone, as a prognostic sign, when 
other favorable indications are absent ; for in almost 
all fatal cases the temperature shows a tendency to 
rise, up to a certain degree. The cramp, which has 
been so long troublesome, ceases at the beginning of 
this stage. The general appearance of the patient is 
quite changed, he looks lively; the blood is restored 
to all parts of the body, and the voice, which has been 
lost, regains its tone. The respiration' becomes easier 
and regular. The patient still feels thirsty, but the 
appetite gradually returns ; he is drowsy aiid sleeps off 



46 CHOLERA AND ITS TREATMENT. 

and on. In some cases a mild type of febrile symp- 
toms appear before the patient completely recovers. 
Occasionally some one symptom becomes very pro- 
nounced and troubles the patient as well as liis physi- 
cian. Vomiting, for one, may persist though all other 
symptoms have abated. This is doe to the congestion 
of the gastro-intestinal mucous membrane, and is not 
dangerous unless gastritis supervenes. Hiccough, for 
another, often accompanies the vomiting, or the latter 
may subside and the hiccough then appear. There 
are some other disturbing symptoms, such as insomnia, 
which is often complained of by patients, slight 
pyraxia, dyspepsia, loss of appetite, flatulence, eruc- 
tations, and feeling of weight in the stomach. The 
increase of temperature at the onset of the stage of 
reaction is supposed by some practitioners to be an 
indication of its commencement. I have heard prac- 
titioners, in talking to one another in cases of cholera, 
say that the patient is probably out of danger as he 
has got fever. The premonitory fever almost alwaj^s 
promises a favorable termination unless complications 
occur. 

IX. The Complications and Sequels occurring in 
the Course of Cholera. 

The complications depend greatly on the length and 
severity of the stage of collapse, as well as on the pre- 
vious condition of the patient. But in almost all 
cases there are some deviations from ordinary conva- 
lescence ; but as long as they are mild they are not 



COMPLICATIONS AND SEQUELS. 47 

much to be feared. Sometimes they assume graver 
forms and, consequently, require separate consider- 
ation. 

Relapse. — Relapse after a fairly established reaction 
is not very common, but now and then cases of 
this kind may be met with. This is generally, I be- 
lieve, brought about by the improper management of 
the stage of reaction. For instance, any ill-management 
of diet would quickly upset the digestive functions, 
which had not been thoroughly re-established, and thus 
there would be the symptoms of vomiting, purging, 
exhaustion, terminating in a comatose condition and 
ultimately in death. 

Imperfect Reaction. — This should not be confounded 
with relapse, though very much similar to it. Many 
patients after passing through the stage of collapse 
become victims of this condition, which is fortunately 
not always fatal. Here the patient has passed through 
the most dangerous and critical stage, but the symptoms 
of recovery are very slow T in their development ; more 
or less purging and vomiting continue. The character 
of these evacuations has changed, but not sufficiently 
to remove apprehension ; the temperature still remains 
below normal, pulse does not improve much ; appetite 
is dull, tongue dry, and the patient does not grow 
daily stronger, but becomes more and more exhausted, 
and ultimately sinks, sometimes with the development 
of typhoid symptoms. 

Typhoid State of Cholera. — This state is not pecu- 
liar to cholera, as it is met with in most other severe 



48 CHOLERA AND ITS TREATMENT. 

acute diseases, such as typhus, typhoid, cerebral fevers, 
etc. The condition is produced by the circulation of 
a retained deleterious product in the blood. This 
material is carried into the brain, and other parts of 
the body as well, giving rise to symptoms common to 
this state. There is a rise of temperature of the body, 
the thermometer indicating that it has gone several 
degrees above normal ; the pulse is very quick, weak, 
small, and compressible. There is general restlessness. 
The renal secretion apparently normal; nausea, vomit- 
ing, excessive thirst, dry mouth, low delirium, and 
soon after coma supervene. These cases may prove 
fatal at any time, so generally the prognosis is very bad. 
Uraemia. — "Very much allied to the previous con- 
dition are the symptoms of uraemia. This state of the 
blood is generally connected with some renal trouble, 
•especially with Bright's disease ; however, similar 
symptoms are to be seen in cases of cholera after the 
stage of collapse, in which the urinary secretion is 
embarrassed. There is some controversy as to the ex- 
act and direct causes of this state ; however, I believe 
most authorities agree that the various symptoms of 
this stage are brought on by a chemical condition of 
the blood, which it subsequently undergoes by the 
accumulation of such material which would have been 
otherwise eliminated as urea and uric acid, but now 
retained in the blood owing to its non-elimination 
through the emunctories, and especially to the imper- 
fect action of the kidneys, which play the principal 
part in the elimination. 



COMPLICATIONS AND SEQUELiE. 49 

The injudicious administration of large doses of 
opium and alcohol is said to have enhanced the devel- 
opment of the ursemic condition. The patient con- 
tinues vomiting and purging. There are sensations of 
weight over the forehead, with vertigo and giddiness; 
the face becomes pale and livid ; the pupils are dilat- 
ed, disturbance of vision ; drowsiness ; ringing in the 
ears ; sometimes deafness and confusion of ideas come 
on in quick succession, culminating in profound pros- 
tration and coma. 

Ulceration of the Cornea. — This condition of the 
eyes requires certain considerations ; of course it is 
common to some other chronic, debilitating diseases ; 
so that even in cases of cholera the previous ill-health 
of the patient facilitates its growth. This is due to 
the imperfect circulation in the part, as well as im- 
proper nutrition. Both eves may be equally affected, 
or one may suffer more than the other. There is dis- 
integration of the epithelial cells, giving rise to small 
superficial ulcerations, which gradually get deeper 
and deeper according to the severity of the individual 
case. This ulceration is so marked that it is detectable 
with an ordinary lens. The corneal surface becomes 
opaque and the sight hazy. All these symptoms leave 
no trace whatever behind, unless in some bad cases, 
but pass quickly away with the recovery of the patient. 
The patient soon regains his normal sight, the cornea 
becomes transparent, and everything goes on normal. 
But in worse cases there may be permanent opacity 
present, or some other serious damage may result. 
4 



50 CHOLERA AND ITS TREATMENT. 

Certain Rarer Forms of Complications. — Certain 
rarer forms of complications may be occasionally met 
with, such as gangrene, bedsores, boils, ulcers, etc. 
Goodeve says that complete gangrene of penis and 
scrotum, and partial gangrene of the scrotum and of 
the point of the nose, are seen among the natives of 
Bengal. He also states that, besides these, cases of 
parotitis come under the observation of the practi- 
tioners. Both parotid glands may be equally affected, 
one after the other. The symptoms of such cases are 
like those of ordinary mumps— low fever, impaired 
appetite, and the mechanical interference with the 
swallowing of food. Deglutition is painful and dif- 
ficult, though these symptoms in themselves are not 
very dangerous in ordinary cases; in some cases of 
cholera they are of very grave import, and often en- 
danger the life of the patient. All these complica- 
tions are more or less due to low vitality and impaired 
innervation. 

I have observed cases of complications which may 
be put under this category, and which are brought on 
by the injudicious administration of drugs ; for in- 
stance, there are cases to be seen in ordinary practice 
in Bengal of excessive salivation caused by the care- 
less external use of some mercurial preparations. 
Oases of chronic diarrhoea and dyspepsia are also met 
with as the result of cholera. 

Uterine Complication. — If pregnant women are 
attacked with cholera, as they often are, some escape 
the attack, others die undelivered, but in the great 



DIAGNOSIS. 51 

majority of cases premature labor sets in, and the 
woman is delivered of a still-born child, generally in 
the collapse stage. These cases should always be con- 
sidered as serious, the occurrence of cholera in the 
puerperal state being invariably fatal; 

X. Diagnosis. 

In the early stage cholera may be mistaken for acute 
irritant poisoning, especially the arsenical, for in this 
stage there are some symptoms common to each, such 
as nausea, vomiting, purging, abdominal pain, intense 
thirst, etc. ; but this difficulty is soon after removed by 
the development of other symptoms, in which the dis- 
eases greatly differ. In cases of irritant poisoning the 
vomit and alvine discharges are usually tinged with 
blood, while in cases of cholera this never occurs, but 
the ejecta resemble rice-water. Besides, in cases of 
cholera, suppression of urine, profuse perspiration, 
shrivelling of the hands and feet, sunken eyes, cramps, 
and other symptoms are present. Epidemic out- 
breaks in the neighborhood also help the diagnosis ; 
in lower Bengal, where the disease is endemic, this 
difficulty may be overcome by carefully watching the 
differential symptoms. There are one or two more 
diseases with which cholera may be confounded, such 
as bilious diarrhoea and choleraic diarrhoea. Though 
at the onset the symptoms of these diseases resemble 
cholera to a certain extent, they never become very 
severe unless, as in some cases, cholera may be devel- 



52 CHOLERA AND ITS TREATMENT. 

oped from previously existing diarrhoea. One more 
distinctive point is tliat in such cases the stools always 
contain bile. But in all cases the patient should be 
carefully watched for some time. 

XL Prognosis. 

The prognosis in cholera is almost always grave, 
and it depends on a variety of circumstances. The 
early part of an epidemic is more dangerous, and the 
number of deaths greater than at its decline. The mor- 
tality is less in its endemic area, and also varies in differ- 
ent epidemics. In some epidemics the percentage of 
deaths is as high as eighty, but generally varies be- 
tween twenty-five and eighty per cent, according to 
the severity of the epidemic. The age of the patient 
must be considered too ; as Mr. Grainger states that 
the liability to fatal attacks increases after the age of 
fifty in both sexes, the age from five to forty-nine 
having the lowest comparative mortality. But I do not 
quite agree with him, for it would be seen from daily 
practice in Bengal that the prognosis is bad when 
strongly-built persons in the prime of their lives are 
attacked; for in cases of robust persons the attack is far 
more severe, and they succumb more rapidly, while I 
have often seen weak, debilitated persons escape from 
an attack, though more predisposed to the malady than 
the former. The mortality is greater amongst the 
poor than the rich ; the simple reason of this fact is that 
the former are usually exposed to bad hygienic condi- 



PROGNOSIS. 53 

tions, and also that circumstances do not admit of their 
obtaining proper treatment in the early stage of the 
disease, or until it is too late, when the chance of recov- 
ery is greatly diminished. Various other circumstances 
peculiar to, but over which they have very little or no 
control, enhance the rapid development of the virus, 
and consequently such cases terminate fatally. The 
previous intemperate habit makes the prognosis bad. 

Now a few words regarding the severity of the disease 
depending upon the development of the different stages. 
In the cholerine stage the disease is not usually fatal ; 
if the patient is properly treated, the disease goes no 
further, and the patient gradually recovers; but in 
most cases this stage is absent, and the disease com- 
mences at once at the second stage, quickly passing 
into the stage of collapse. In this second stage, if 
there is too great an exudation of serum and too per- 
sistent vomiting, the patient soon becomes exhausted, 
and the chance of passing into the next stage is greatly 
increased. While, on the other hand, if the second 
stage is prolonged and the symptoms are ill-devel- 
oped, then there is little chance of the development 
of the next stage, and the patient, without going 
through the most dangerous stage, gradually recovers. 
The danger of the next stage is always very great, and 
this increases with the severity of the symptoms and 
unusual prolongation of the stage. The lividity of 
the surface ; profuse cold, clammy perspiration ; the 
disappearance of the brachial pulsations; undue inter- 
ference with respiration ; suppression of urinary secre- 



54 CHOLERA AND ITS TREATMENT. 

tion, and the advent of typhoid symptoms, are always 
indications of fatal issue. Among some favorable indi- 
cations, the gaining in strength of the radial pulse, 
quiet respiration, gradual return of circulation, ten- 
dency to sleepiness, gradual rise of temperature, and 
grayish, thick stools, with the cessation of other dis- 
turbing symptoms, may be reckoned as indications for 
a hopeful prognosis. With the establishment of the 
reaction stage the chances of recovery increase, though 
now and then cases end fatally even after almost com- 
plete disappearance of the dangerous symptoms. The 
complications of graver kind often lengthen the dura- 
tion of the disease, and the prognosis becomes serious. 
Duration of cholera is verv variable : some cases termi- 
nate within a few hours to two or three days. 

XII. Morbid Anatomy. 

As in cholera death may take place at any time in 
the course of the disease, so the post-mortem changes 
vary according to the advancement of the stages. But 
usually death takes place either in the stage of collapse 
or that of reaction, so it will be better to consider the 
post-mortem changes under two principal heads : first 
and most common in the collapse stage, and then in the 
stage of reaction. 

When death takes place in the stage of collapse, the 
following phenomena will be usually met with if 
searched for shortly after death, for I have often no- 
ticed in the post-mortem room 'that the post-mortem 



MORBID ANATOMY. 55 

signs vary according to the time which has elapsed since 
death: The features are pinched and shrunken, and the 
body is moderately nourished, or sometimes emaciated, 
the rigor mortis is developed within a few minutes 
of death, first the back of the neck and lower jaw, 
muscles of the face, front of the neck, chest, and upper 
extremities, and then the lower extremities. So that 
when it is fully developed the forearm and legs are 
contracted on the arms and thighs ; and in some cases 
the forearms are so contracted as to cross each other, 
assuming an attitude of prayer : which has been men- 
tioned in old works as an attitude of prayer in last 
moment of life, while we know now this is certainly 
due to rigor mortis. The bluish or purplish discol- 
oration due to the hypostatic congestion is to be noticed 
at the back of the neck, on the whole of the back of 
the body, and the posterior aspect of the thighs ; in 
fact, all over the dependent parts. The skin of the 
fingers and toes presents a shrivelled-up appearance, 
as if they w T ere soaked in water for a considerable time. 
This shrunken appearance gradually diminishes. 
The temperature, which begins to rise just at the close 
of life, continues to do so until it has risen two to four 
degrees above at the time of death : e.g., if the tem- 
perature of the body before death be 96° F., it would 
rise after death to 98° or 99° F. This fact might be 
attributed to the muscular movements which the mus- 
cles undergo just before and subsequent to death. 

Head. — It is more or less congested ; the scalp pre- 
sents somewhat livid and pale appearance. The dura 



56 CHOLERA AND ITS TREATMENT. 

mater is dark, and the vessels of the pia mater are 
loaded with dark blood. The brain-substance itself is 
more or less hyperaemic ; nothing very special is to be 
noticed in the brain ; the ventricles are generally 
empty. Thudichum asserts that the nerve-tubules and 
ganglionic cells of the gray matter become affected, 
"that the axis cylinder separate and the nerve-mar- 
row curdles." The spinal cord on section appears, 
like the brain-subsfance, hypergemic, and contains a 
large quantity of dark fluid. 

The Thorax. — The heart and the lungs are the two 
principal organs that remarkably suffer in this region. 

The Heart. — The right cavities of the heart, as well 
as the pulmonary artery and the vena cava, become dis- 
tended with extraordinarily thick and dark blood. 
The left cavities are empty, or nearly so, compared to 
the right side, but not absolutely so, for the left au- 
ricle and ventricle and the pulmonary veins almost 
always contain a little blood. 

The Lungs. — These are found very much in the 
state of collapse. On opening the thorax they are 
seen, instead of overlapping the heart, pressed back- 
ward and shrunken. They are lighter in weight, less 
crepitant, less spongy, and less tough than normal. 
On section the cut surfaces look pale grayish or pink- 
ish gray, showing the anaemic condition of the pul- 
monary tissue ; but if this cut be made at the root of 
the lungs there will be oozing out of blood from the 
vessels, staining the pulmonary tissue, which is at first 
dark and then soon after exhibits a hypenemic ap- 



MOKBID ANATOMY. 57. 

pearance. So we should judge the condition of the 
lung-tissue at our first incision. Drs. Chakrabartty, 
Macnamara, and others have noticed the congested 
condition of the lungs in some exceptional cases of 
death from cholera. This state of lungs greatly de- 
pends on the time at which the post-mortem examina- 
tion is made after death. If the examination is made 
after a number of hours (say six or seven), there is a 
tendency for blood-serum to exude into the surround- 
ing parts, and thus to produce infiltration. So, in 
order to obtain an accurate knowledge of this state of 
the lungs, the examination must be performed within 
a short time after death. 

Before passing on to the abdomen I should like to 
consider the state of the larynx, trachea, and bronchi. 
The mucous surface of this region assumes a pale and 
livid appearance. The epithelium of the nasal pas- 
sages and mouth is destroyed, and consequently the 
cholera patient in the complete stage of collapse loses 
the power of taste and smell. The papillae circum- 
vallate of the tongue and the mucous papillae of the 
pharynx and oesophagus are somewhat enlarged and 
stand prominently on the surface ; their apices are 
distinguished by dark spots. 

Abdomen. — The muscles of the abdomen become 
flabby, and there is distinct dark, purplish discoloration 
in them. On opening the abdomen the peritoneum 
is found injected with rosy pinkish coloration. 

Stomach, — The stomach is very much contracted, 
and its normal mucous surface is somewhat congested 



58 CHOLERA AND ITS TREATMENT. 

and covered with viscid mucus. Sometimes there is 
found medicine which has been given during life, but 
has neither been absorbed nor has it passed further. 
The glandular structures are usually swollen, and the 
shedding of the epithelium is not uncommon. 

Intestines. — The discharges in the small and large 
intestines are different. The folds of the small intes- 
tine stand out prominently, and, on squeezing, a kind 
of fluid matter will be found to escape. In duode- 
num the glandular structures are very marked, while 
the rest of the mucous membrane is apparently hale 
and sound, either of red or of pinkish color, or is more 
commonly in patches of arborescent vascularity, alter- 
nate with dull white patches. The valvulse eonni- 
ventes are thick, cedematous, and doughy ; the solitary 
and agminated glands are prominent, raised a few 
lines above the surface, and usually very marked. 
Peyer's patches are distended with a whitish material, 
and the mucous membrane is in some places ecchy- 
mosed, and in others denuded and rough-looking, 
owing to the shedding of the epithelium. The 
small intestine is distended with fluid similar to that 
evacuated during life, but this fluid is usually a little 
thicker, and if allowed to stand for a while it would 
divide into two portions, one thicker, which settles at 
the bottom, and the other a paler rose-water-looking 
fluid, which floats on the surface. Under the micro- 
scope this fluid is seen to contain epithelial cells, 
either quite separate and distinct or agglomerated 
into clusters, each little mass containing some twenty 



MOKBID AKATOMY. 59 

or thirty epithelial corpuscles. Besides these there 
are spheroidal cells present in the fluid, showing the 
destruction of the glandular structure ; the rest of the 
material consists mostly of serum or serous fluid, not 
unfrequently blood and blood-corpuscles, though occa- 
sionally bile also is present. 

The large intestine is collapsed, especially the colon, 
which is extremely collapsed and shrunken, and con- 
tains almost nothing. The glandular structures of the 
intestine are opaque. 

Mesenteric Glands. — The mesenteric glands, espe- 
cially those connected with duodenum, are hypersemic, 
and the gland-tissue soft and oedematous. 

Liver. — The liver does not participate in any very 
remarkable change ; occasionally there is a shrinking 
of the capsule, due to the draining away of the serous 
fluid from its substance. Incision shows the paren- 
chyma to be pale, and there is evidence of venous con- 
gestion. 

Gall-bladder. — The gall-bladder is full of bile, 
which is thick, inspissated, and of peculiar consistency, 
and very dark color. 

Spleen. — The spleen is smaller than normal, and is 
somewhat dark in color, w r ith shrinking of the cap- 
sule like the liver. There is nothing remarkable seen 
in the pancreas. 

Kidneys. — As regards the kidneys, these organs are 
hypersemic. The superficial veins exhibit stellate ap- 
pearance all over the surface. Both cortical and pyra- 
midal structures undergo venous congestion, the latter 



60 CHOLEKA AND ITS TREATMENT. 

more marked than the former. The tubules are filled 
with a fluid consisting of granular epithelium and 
debris. 

Urinary Bladder. — The bladder is collapsed and 
empty. Its epithelial surface does not undergo any 
change except slight opacity. 

In the Stage of Reaction. — Now we shall consider 
the morbid changes that take place when a patient dies 
in the stage of reaction. Even in cases of death in this 
stage there is a great variation from its commencement 
to its perfect establishment. So, if a patient dies just 
at the commencement of this stage, there is little or 
no difference in the post-mortem changes from those 
of death in collapse ; but when the reaction is fairly 
established, the post-mortem appearances are greatly 
modified. The shrinking appearance of the general 
surface of the body disappears and the body becomes 
rather plump. 

Head. — There is a slight venous congestion in the 
brain, as well as a slight effusion of its membranes. 

Lungs. — No collapse of the lungs is to be met with 
in this stage, but on section the parenchyma of the 
lungs looks congested or hypersemie. In rare in- 
stances the lungs suffer inflammatory changes, as 
pneumonia and consolidation. 

Heart. — In the heart there is not much difference 
in both sides between this stage and that of collapse. 
Sometimes there may be present coagula on the left 
side. 

Stomach. — The whole of the mucous membrane of 



MOEBID ANATOMY. 61 

the stomach is vividly injected, and the glandular 
structure prominent. In parts there are denuded 
mucous surfaces in the state of repair. Pns may be 
present, as a considerable quantity of pus is often 
passed with the stool in this stages during the life of 
the patient. The presence of this fluid may be ex- 
plained as due to a process of repair in parts of the 
mucous membrane of the alimentary tract. 

Kidneys. — The kidneys in this stage are large and 
deeply ingested. On section, a large quantity of dark 
blood exudes in drops, showing the unusual congestion 
of the organ. The tubules are blocked up with a 
whitish material consisting of disintegrated shreds of 
epithelium and albumen. These shreds or epitheliums, 
oil-granules, and debris filling lip the tubules give them 
an opaque appearance. These particles are to be often 
seen if the urine is examined when first passed by a 
patient during the stage of reaction. So, in fact, these 
organs very much resemble those of acute desquama- 
tive nephritis, the characteristics of which I need not 
enumerate here. The liver, spleen, pancreas, etc., as- 
sume their normal appearance and activity with great 
rapidity. 

In accordance with .the secondary complications, 
there may be present in the dead body ulcerations on 
the skin, gangrenous patches, suppurative glands, gan- 
grenous lungs, etc. But these are by no means char- 
acteristics of cholera. 



62 CHOLERA AND ITS TREATMENT. 



XIII. The Condition of the Blood and the Se- 
cretions in Cases of Cholera during Life. 

Here I should like to consider the changes that the 
blood and the secretions undergo in cases of cholera. 
The blood undergoes considerable changes ; and as re- 
gards the latter, they are more or less dependent upon 
the morbid changes of the blood. So I shall take up 
the consideration of the blood first. 

Condition of Blood. — The blood in cholera has been 
carefully, both chemically and microscopically, exam- 
ined by Drs. Parkes, Garrod, Schmidt, as well as by 
several others, and they are considered to be the best 
authority with respect to the chemical analyses of blood 
in this disease. The most prominent and remarkable 
phenomenon that is to be noticed is the separation 
of water and salts which takes place in the intestinal 
flux. As a result of this there is a retention in the 
blood of an excessive quantity of albumen and cells, 
with a considerable diminution of salts and fibrin ; as 
regards the absolute diminution of the quantity of the 
latter, it is a dubious point, but its coagulability is 
greatly diminished without any doubt. These changes 
in the blood generally take place in the early stage of 
the disease. The watery constituent of the blood is 
affected first, and transudes before the solids. Amongst 
the salts there are differences in reference to their capa- 
bility of diffusion. So some exude before the others. 
The chlorides transude before the phosphates, and the 



THE CONDITION OF THE BLOOD. 63 

salts of sodium before those of potassium. Soon after, 
an important change occurs in the blood-substance 
itself. The normal current of diffusion from the fluid 
of the blood to the corpuscles takes an inverse course ; 
that is to say, the current, instead of passing from the 
fluid into the cells, now passes from the cells into the 
fluid, which is in a state of continued transudation 
through the intestinal mucous membrane. In this 
process of diffusion it obeys the same laws as in the 
case of intestinal flux. So the blood-globules soon lose 
their fluid and saline constituents. It has been observed 
by Dr. James M. Cowen in a rare instance, in a case of 
a woman who died of cholera, that the blood-disks, es- 
pecially the white, had undergone a remarkable altera- 
tion. They generally assumed a circular shape, while 
a few of them were caudate with well-deflned external 
border. When seen edgeways they were flattened, 
and were found to be in the extremely increased pro- 
portion of one to seven of the colored cells. It is 
doubtful whether these changes are to be noticed in 
all cases of cholera. 

However, it is manifest that the character of the 
blood changes in proportion to the loss of its constitu- 
ents. The density of the fluid increases, and the spe- 
cific gravity is also higher than normal. While this 
transudation is going on in the intestinal canal, there 
is a diminution of the diffusion-currents from the blood 
to the various tissues, and at last, on account of the in- 
creased density of the blood, an inverse current estab- 
lishes from the latter to the former, so that the volume 



61 CHOLEKA AND ITS TKEATME^T. 

of the blood is increased by the additional moisture 
from the surrounding parts. In this way the fluids 
that are drawn from the vessels, viscera, and other parts 
are loaded with metamorphosed products from the 
tissues, which under ordinary circumstances would be 
quickly eliminated from the blood through their nor- 
mal passages. This process of elimination is greatly 
in abeyance ; there is continued accumulation of de- 
leterious materials in the blood, and consequently the 
blood cannot properly perform its normal functions. It 
is well known that the blood-globules participate largely 
in the respiratory and heat-producing processes of the 
body ; so their destruction and deterioration as well as 
the draining of the salts from the system in general 
cause the cyanotic appearance and lowered heat of the 
body. Dr. Partes says : " Knowing the great share 
taken by the blood-globules in the respiratory and 
heat-producing processes, it is scarcely possible to 
avoid concluding that their loss of salts is connected 
with the characteristic cyanosis and lower temperature 
in cholera. In most cases there is vomiting and purg- 
ing before there is loss of heat, though this very soon 
follows in a slight degree, and then gradually aug- 
ments. In other words, the diarrhoea coincides with 
the first or early chemical changes in the blood — the 
transudation of some of the constituents of the serum. 
The lowered temperature follows afterwards, at the 
time when we know that diffusion from the blood-cells 
into the serum must be taking place, and augments 
gradually as the diffusion increases." 



THE CONDITION" OF THE SECRETIONS. 65 

Sometimes peculiar substances like butyric acid and 
ammonia are found in the blood of cholera patients. 
Dr. Thudichum shows that this is due to an imbibition 
of the butyric acid from the intestines themselves. 
The color of blood sometimes is intensely dark, but 
capable of recovering its normal hue when exposed to 
the air. There is no chemical evidence of the pres- 
ence in the blood of a special poison. 

The Changes in Secretions. — We know in all pro- 
cesses of secretion blood plays an important part. So 
any abnormal condition of the blood puts the secretions 
in abeyance, and the secretory organs are unable to per- 
form their proper functions : in cases of cholera, as we 
have seen, the blood suffers much, and so upsets the 
whole secretory system. I should commence the con- 
sideration of the changes of secretions with 

Saliva. — This is very largely increased during the iirst 
stage of the disease, but when the disease has advanced 
a little further it is greatly diminished, and the patient 
experiences an unusual dryness of the mouth, and 
throughout the whole of the buccal cavity down to 
the throat there is a sensation of dryness, with con- 
stant desire for drink. This state lasts for a consider- 
able time, in fact until the reaction sets in, when the 
salivary secretion again becomes normal. Chemically, 
it does not undergo any change, but it becomes a little 
thick and tenacious. In exceptional cases the salivary 
glands themselves are complicated, giving rise to ab- 
scesses or parotitis. 

Intestinal Secretions. — It is very difficult to obtain 
5 



66 CHOLERA AND ITS TREATMENT. 

the secretions of the different internal organs separate, 
as they are usually mixed with the intestinal discharges. 
In the advance stage of the disease, the function of 
the secretory organs almost stands still; so we will take 
up the consideration of the evacuation itself. 

Consideration of the Evacuation. — The quantity of 
fluid evacuated varies from eighty to one hundred and 
fifty ounces ; the specific gravity seldom exceeds 
1012 ; the reaction faintly alkaline or neutral. Parkes 
says that the liquid portion is not pure serum of blood, 
for it contains less albumen, but still it is serous in 
its nature. It consists principally of water with a con- 
siderable amount of salts and a small qtiantity of albu- 
men. Traces of blood may be sometimes found. The 
salts are chlorides of sodium and potassium, and also 
phosphate, carbonate, and sulphate of soda in the pro- 
portion of seven or eight parts per thousand. The 
greatest loss from the blood is water ; for every hun- 
dred ounces of the fluid abstracted nearly 98 or 99 oz. 
are water, and about one per cent salts. There is very 
great difference of opinion held by different authori- 
ties with respect to the microscopy of these evacuations. 

First of all with respect to the flocculent material 
contained in the rice-water ejecta. Dr. Parke says 
that it is a modification of fibrin, while Dr. Gardner 
claims that it is " altered mucus." Those who hold 
the parasitic theory believe the flocculent material con- 
sists of altered epithelium in a state of degeneration, 
brought on by the morbid poison — the fungi. It is 
argued that any epithelium found after death is the 



THE CONDITION OF THE SECRETIONS. 67 

result of post-mortem laceration, and is not therefore a 
result of any vital phenomenon. Those who subscribe 
to the bacteria theory also say that the altered epithe- 
lium constitutes the flocculent material. It appears 
that these statements have been exaggerated, and much 
epithelium is due to post-mortem laceration, so that 
there are two views on the point : (1) greater portion 
of epithelium is the result of post-mortem laceration, 
or (2) due to mortification of parasite or bacteria; and 
the parasitic theory rests a good deal upon this. Haley 
in Germany went so far as to describe distinct organ- 
isms which he called " cystosporangia,'' and which he 
thought were invariably evacuated in the same way as 
Drs. Macnamara and Pacini thought the granular con- 
dition of epithelium was due to micrococci. Both 
these questions, What are these contents ? and, How 
far are they connected with fungi? are elucidated by 
Drs. Lewis and Cunningham, who are the best authori- 
ties on the subject. Their investigation has led them 
to disbelieve the fungoid theory of the origin of stools. 
There is, they say, no specific cyst or sporangia to be 
found in the cholera stool. 

With respect to the nature of the flocculent material, 
there is a good deal of epithelium, which is not 
caused by vibrionic or bacteroid change ; but due to 
disintegration of epithelial cells in general by natural 
process of death, and the firmer constituents of it 
are fibrin and blood-plasma. This view has been held 
by Dr. Parke, and here I give his analysis of the dis- 
charge in a tabular form : 



68 



CHOLEItA AND ITS TREATMENT. 



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THE CONDITION OF THE SECRETIONS. 69 

Bile. — The liver itself does not undergo any re- 
markable change, and the secretion of bile goes on 
normally during the early stage of the disease ; but 
later on, when watery discharge comes from the intes- 
tinal canal, the blood loses most of its watery constit- 
uent and thus becomes thicker and thicker, and cannot 
easily pass through the small capillaiy blood-vessels of 
the liver. Besides, the blood, which in its normal 
state undertakes some share in the manufacturing of 
certain constituents of the bile, is now deprived of 
that activity. The hepatic cells continue their work 
under this anomaty, though their normal functions 
are very much diminished. The product of the ac- 
tivity of these cells accumulates in the gall-bladder. 
There is very little or no discharge of this secretion into 
the intestinal canal. As we all know, the acid contents 
of the stomach passing over the oriiice of the biliary 
duct set forth a reflex action on the muscular wall of 
the gall-bladder and ducts, which contract and cause 
a profuse discharge of the bile from its reservoir. 
This normal process is arrested by the alkaline con- 
tents of the stomach and duodenum in cases of cholera. 
So, in cases which terminate fatally, the gall-bladder is 
found distended with this fluid, but in favorable cases, 
as soon as the reaction sets in, the bile immediately 
conies into play, as I have already noticed. 

Urinary Secretion. — The kidneys suffer more than 
the liver. The veins of the papillse become congested 
and the epithelial cells slightly alter their shapes. In 
the early stages there is not much alteration to be 



70 CHOLERA AKD ITS TREATMENT. 

noticed in the urine, except that it becomes less and 
less in quantity ; but in fully developed cases of chol- 
era the secretion of urine is entirely stopped. This is 
due to the diminishing watery constituent of the 
blood itself, which is drained away with the intestinal 
flux, and also to the diminished general blood-pressure, 
which is evident in the slow action of the heart. So 
this organ is deprived of its normal activity for several 
hours ; and sometimes it is so long that if nature had 
not otherwise provided for the elimination of the 
effete matter that should have passed through this 
organ in its normal state, the case would have ended 
shortly in coma and death. But during the inactivity 
of the kidneys the fatal termination, with the develop- 
ment of ursemic symptoms, is delayed by the excre- 
tion of the effete matter through the mucous surface 
of the stomach and intestines. Now, if the patient 
survives this stage the function of this organ is 
restored gradually. The excretion of urine comes on 
slowly, and later than the other secretions. When it is 
first discharged after this stage, it is found to be small 
in quantity, high-colored, acid in reaction, and has a 
peculiar odor, almost always containing albumen and 
epithelial cells. 

XIY. Treatment. 

The treatment of cholera may be considered princi- 
pally under two heads : first, the preventive treatment ; 
and secondly, the curative, under which come all kinds 
of treatment, hygienic, medicinal, and dietetic. 



TREATMENT. 71 

Preventive Treatment. — This is an important mat- 
ter during cholera epidemic, and first calls our atten- 
tion. All the hygienic principles should be strictly 
carried out. It is impossible to describe in detail all 
the hygienic principles in a small work like this, but I* 
shall just enumerate a few : 

1. Cleanliness must be observed as particularly as 
possible in its every minute detail. 2. Free ventilation. 
For this purpose the windows should be kept open so 
that there may be free communication bet wen the inter- 
nal and external air. This must be especially observed 
in cases of poor people who live generally in close and 
ill-ventilated rooms. 3. Too much overcrowding must 
be avoided. 4. Disinfectants should be freely used 
in and around houses, especially in places where there 
is accumulation of filthy matter. 5. The water-supply 
must always be pure; the drinking-water should be 
thoroughly filtered. 6. House-drains, street-drains, 
sewers, water-closets, privies and ditches, etc., should 
be examined carefully over and over to see that they 
are in proper order. 7. The practice of quarantine dur- 
ing cholera epidemic is a good plan, though we are quite 
ignorant of the nature of the poison and its mode of 
operation. But it has been seen during various epi- 
demics that the poison has been carried from one place 
to another by intercommunication. It has been also 
found during different epidemics that quarantine stops 
short the spread of the disease. 8. The most important 
point is to attend to the evacuations from the bowels, 
and ejecta from the mouth, of the cholera patient, 



72 CHOLERA AND ITS TREATMENT. 

which are generally supposed to be the bed of cholera 
poison. These are carried generally through the body- 
clothes or bed-clothes of the patient, or through the 
fometis of the attendants. The walls, floors, and the 
furniture of apartments often get soiled with these 
evacuations, which, if no proper means be taken for 
their disinfection, would generate fresh cases of chol- 
era. The urinals, bedpans, and the spitting- pots are 
required to be thoroughly disinfected before they are 
used. The evacuations themselves should also be care- 
fully disinfected before they are thrown away. These 
should not be thrown into the water-closets or privies, 
but they should be buried a considerable depth under- 
ground, in such a place where they cannot be commu- 
nicated to any pool or water stream, of course being 
previously mixed with disinfectant fluid. For the 
disinfectant purpose, chloride of lime and water, or 
carbolic acid, or Condy's fluid may be used. The 
soiled clothes can be disinfected by being soaked in 
the disinfecting solution, or if they are of linen or 
other washable material they can be boiled after 
having been soaked in Condy's fluid or carbolic acid 
solution. This process of disinfecting gives complete 
immunity, so I do not think it advisable that these 
things should be burned as many recommend. Those 
substances that cannot be boiled but can stand being 
baked may be submitted to a temperature above 212°F. 
The floor, paint, furniture, and all suspected articles 
must be washed with chlorine water or with acidulated 
solution before they are used. The acid has a great dis- 



TKEATME2STT. 73 

infecting power as regards cholera poison. The poison 
whenever it comes in contact with acids, either in 
the water or soil, or acid gases in the atmosphere, is de- 
stroyed. Thus nature has a destructive agent. So in the 
human economy also there is a natural preventive, the 
acid secretion of the stomach. This fluid when suffi- 
ciently secreted acts to a certain extent as a preventive 
against cholera. Acid drinks during cholera epidemic 
may be recommended as a prophylactic ; for this pur- 
pose sulphuric-acid lemonade may be used. The prophy- 
lactic power of acid has been proved on several occa- 
sions. When the disease breaks out in a small confined 
area, such as on board a vessel, etc., the preventive 
effect of acid is well seen. 

With regard to the disposal of corpses, they should 
be burned, as with some nations who follow T the cus- 
tom of cremation ; and with those who think this a 
cruel custom, or who are prejudiced against it, the 
corpse should be buried as soon as possible. The 
coffin should be thoroughly disinfected either with 
lime, charcoal, or carbolic acid. 

The burning of sulphur as a prophylactic measure 
has been strongly advocated by Dr. J. E. Tuson, who 
has written a paper on the subject and has cited nu- 
merous instances to show its marvellous effect in the 
prevention of cholera epidemics. I think the burning 
of sulphur in the production of sulphurous acid would 
undoubtedly act as a disinfectant and antiseptic. Due 
to the antiseptic property of sulphurous acid, it has 
been introduced in the modern antiseptic surgery, and 



71 CHOLERA AND ITS TREATMENT. 

is used by many surgeons. It . prevents the fermen- 
tation, and consequently stops any further proliferation 
of the materies morbi. 

Now a few w T ords to my Indian readers, who are 
aware of the fact that it is customary in greater part 
of India to burn resin or sometimes sulphur every 
evening. This mode, though gradually dying out, is 
strictly observed by lower class of people and the 
shopkeepers as one of several other superstitions. I 
am glad to say it has been based upon purely scien- 
tific principles ; but unfortunately most of the people, 
not knowing its scientific operation, follow^ it as a cus- 
tom, and consequently they burn so sparingly, some- 
times only a few grains, so that little or no effect is 
produced. But I must admire the principle, and it is 
doubtless one of the most handy and simple means of 
disinfecting close and ill-ventilated rooms. What I 
wish to impress on my readers is that its object is that 
of disinfecting the atmosphere, and should not be 
blindly used as in Bengal as customary. I think dur- 
ing cholera epidemic, if we all follow that custom 
which is prevalent in Bengal, and burn a considerable 
quantity of sulphur every evening in every house, we 
can without much trouble or expense secure an atmos- 
phere sufficient to destroy the cholera germs or poi- 
sons, if they be floating in the air. 

The room of a cholera patient may be disinfected 
by some volatile disinfectants ; or Condy's fluid may 
be atomized (reduced into minute particles) by means 
of spray-producers. I think the best and the most 



TREATMENT. 75 

convenient way is to keep the room filled with car- 
bolic-acid fumes or sulphur fumes for some hours, the 
windows and doors being closed. After its thorough 
fumigation, the windows must be thrown open for 
some time. 

A heavy rainfall may stop a cholera epidemic, or at 
least has great influence in diminishing the mortality. 
Similarly a thunder-storm or a great fire in the epi- 
demic area will greatly mitigate its turbulent charac- 
ter, if not complete stoppage. 

Now, before I leave this subject, I shall say just a 
few words as to the individual precautions during 
cholera epidemic. 1. All sorts of exposure should be 
carefully avoided, such as exposure to cold, to damp, 
or to rain ; wearing wet socks and boots also to be 
avoided. 2. The body must be kept clean and mod- 
erately warm. 3. Late hours should be avoided. 4. 
Habits must be regular. 5. Food should be simple, 
nutritious and easily digestible, and that to which one 
is quite accustomed. Too richly cooked dishes, or oleagi- 
nous substances which are hard to digest, should, if re- 
quired, be taken in great moderation. The substances 
that previous experience has shown intolerable to one 
must on no account be taken. All that I have stated 
under the heading of Exciting Causes must be guarded 
against, especially intemperate habit 5 eating putrid 
animal matter and unripe fruits, etc. 

The hypochondriac tendency and the melancholy 
mood should be suppressed as much as possible, for it 
is very likely that this vital depression would act as a 



76 CHOLERA AND ITS TREATMENT. 

predisposing cause, giving rise to cholera, or it might 
give rise to several other phenomena in the body which 
would act as the predisposing or exciting causes. Any 
purgative medicine should, if used at all, be carefully 
taken ; in fact, no purging would be advisable except 
in unavoidable cases, when mild purging or enema 
might be administered. 

The Curative Treatment. — As we have seen, there 
have been various morbid phenomena brought forward 
by different authorities as the true and immediate causes 
of the disease ; and with these the rationale of treat- 
ment in cases of cholera greatly differs. This will be 
evident if we refer to the treatment of Dr. Johnson, 
who, being thoroughly convinced that the poisoning of 
the blood is the immediate cause of the disease, treated 
his cases on eliminative principle by means of purga- 
tive drugs, such as castor-oil and the like. There is no 
doubt he treats his cases with a great success. I pre- 
sume this may be explained on the supposition that 
during the diarrhceal stage the purgative medicines 
would greatly increase the chance of recovery of the 
patient, if there are irritative substances in the stom- 
ach or intestinal canal that have been the proximate 
cause of setting up the evacuations. And again in the 
reaction stage, purgative medicines are now and then 
useful to carry through this stage quietly. I do not 
think this class of medicine is of any use in any other 
stage of the disease ; even in cases where there is no 
trace of irritative matter in the intestinal canal, the 
astringent medicines will act far better than the purga- 



TREATMENT. 77 

tives ; so in the use of purgatives even in the diarrhoeal, 
stage we must exercise our discretion. 

Venesection. — Venesection as a remedial agent in 
cases of cholera, especially in the stage of collapse, has 
been advocated and practised by many physicians. In 
1828, twenty patients were admitted into the cholera 
hospital of her Majesty's 20th Regiment in India, and 
were bled, of whom seventeen died. This evidently 
shows that this is not a method of treating cholera pa- 
tients to which we can give any importance whatever ; 
fortunately however, this mode of treatment has been 
universally abandoned, and is not followed even by its 
most zealous supporters. 

Charcoal. — The administration of small or large 
doses of charcoal has been practised by many on the 
supposition that charcoal acts as an antidote to cholera 
poison. I doubt very much as regards its antidotal 
property, but in some cases of cholera in early diar- 
rhoeal stage it may be administered with good result. 
It must be remembered that the action of charcoal is 
more mechanical than chemical. 

Transfusion or Injection. — As there is no doubt 
that the blood in cholera patients becomes extremely 
thick, so much so that it can hardly circulate through 
the blood-vessels, and in most cases death takes place 
owing to this condition of blood, some ingenious 
practitioners have tried to replace the watery constitu- 
ents of the blood by injection into the veins of a cer- 
tain quantity of saline solution or serum. The im- 
mediate effect of this injection is no doubt to add 



78 CHOLERA AND ITS TREATMENT. 

to the liquidity of the blood, and consequently the 
patient, who has previously appeared shrivelled and 
shrunken owing to the draining away of an unusual 
quantity of the serum of the body, now looks much 
more animated. But on the whole this does not prove 
a successful way of treatment in cases of cholera. 
There is a great drawback in such operation, which in 
fact compels us to abandon it completely. The pro- 
pelling force of the injected fluid allows the deleterious 
product of the blood which has been already collected 
in the fluid, not having been eliminated by the excre- 
tory organs, now to circulate more freely in different 
parts of the body, giving rise to most distressing symp- 
toms ; for instance, when it reaches the brain there is 
apoplectic seizure, terminating in death. . 

Allopathic Treatment. — I shall take up a typical 
case of cholera, and state in a few words the plan of 
treatment usually adopted by allopathic physicians in 
the different stages of the disease. 

During the first stage very little or no treatment 
is required ; but if there be diarrhoea present, it may be 
treated as a simple ordinary case of diarrhoea. 

During: the first and second stao-e the internal ad- 
ministration of sulphuric acid in fifteen-minim doses 
has been strongly recommended by Dr. Macnamara. 
The combination of sulphuric acid and nitric acid has 
considerable success in early or choleraic stage of the 
disease. These drugs act as astringents, refrigerants, 
diuretics, and lastly as tonics. 

One precaution should, however, be taken in the 



TREATMENT. 79 

administration of this acid, that it should not be 
given in too large doses, as there are chances of giving 
rise to other unpleasant symptoms, for when given in 
too large doses it is apt to irritate the gastro-intestinal 
canal. 

It is very highly recommended in cases of cholera* 
During the epidemic in 1873, the deaths in cases which 
were treated with this acid amounted to eight per cent, 
while in cases where other remedies were used the per- 
centage of deaths oscillated between twenty-three and 
forty-nine per cent. In the evacuation stage there are 
two principal methods of treatment : one by means of 
purgatives, such as sulphate of magnesia, calomel, cas- 
tor-oil, etc.; and the other the astringents. The latter 
is now principally followed by physicians. Opium in 
full doses is a great remedy for this purpose, either in 
the form of pill, tincture, or powder ; other astringents, 
such as acetate of lead, tannin, and gallic acid, are given 
in various proportions. 

Collapse. — During this stage nothing but stimu- 
lants, such as ether, ammonia, and alcohol, etc., are 
given. They are pushed in some cases to such an 
extent that if there is chance of rapid reaction, this is 
delayed by the injudicious administration of alcohol 
and other stimulants during this stage. I shall state 
presently how this takes place. When a dose of alco- 
holic stimulant is prescribed for a cholera patient in 
cold stage, it does not act; its action is almost nil, 
now, as this mode of treatment is continued, and re- 
peated doses of stimulants are given to wake up the 



80 CHOLERA AND ITS TREATMENT. 

patient. But, as I have said, its action is almost nil, 
whatever quantity one may use ; for the absorbing sur- 
face has lost the power of absorption, and thus the 
stimulant, instead of being absorbed, partly drains 
away, though very little, and the rest is left in the 
stomach and intestines. When reaction commences and 
the absorbing surface regains its power, the bad effect 
of excessive stimulants begins. The accumulated 
stimulants are now absorbed into the system and give 
rise to troublesome symptoms. So indiscriminate use 
of stimulant, especially the alcoholic, in cases of cholera 
must be carefully avoided. I can suggest, that in cases 
where alcoholic stimulants are used, if the physicians 
after a dose or two find neither the pulse nor the tem- 
perature is increasing, it is pretty certain that this 
medicine given internally will not act ; it is not because 
the stimulants have lost their stimulating power, but 
simply because, as I have said, the absorbing surface of 
the stomach and intestines has lost the power of absorp- 
tion ; so this is a good indication for immediate stop- 
page of such stimulants. If the physician still wants 
to administer stimulant he might try some other way, 
but always bearing in mind that the injudicious exhi- 
bition of stimulant not only produces a bad effect in 
this stage, but also in the next stage, for which he only 
is to blame. 

When there are pain and cramps, etc., some local 
measures are taken, such as sinapism, hypodermic in- 
jection of morphia, inhalation of small quantity of 
chloroform, but mainly friction, simple or medicated 



TREATMENT. 81 

with turpentine or chloroform liniment. In some cases 
cold water or ice may be applied. 

Reaction Stage. — Tonics, such as iron, etc. Com- 
plications must be treated as they arise. 

The following prescriptions will give a general idea 
of the treatment that was adopted in cases of cholera 
by different physicians during the epidemic of 1873 in 
America. The average percentage of death was be- 
tween 23 to 49. 

Prescriptions. — 1. Chloral hydrate exhibited a 
most satisfactory result in arresting the vomiting and 
purging in cases of cholera, and alsa in inducing sleep 
with complete convalescence. 

2. Mercury, opium and astringents, bromide and 
chlorate of potash, ammonia, chloroform, carbolic acid, 
dry heat. During the convalescence mercury and 
opium in alternate doses. 

3. Dry heat at the extremities, ice-bag at the spine. 
Iced water ad libitum, and small doses of calomel. 
Now and again hypodermic injection of opium. 
(Dr. S. Allen. This physician treated a case of 
pregnant woman with good result and without mis- 
carriage.) 

4. Morphia, calomel, and iced water. 

5. Morphia, capsicum, calomel internally ; atropia, 
and quinine hypodermically. 

6. Opiates, astringents, and mercurials in the early 
stage. In some cases diluted sulphuric acid and tinc- 
ture of opium. 

7. Mercurials, opiates, astringents, and stimulants. 

6 



82 CHOLERA AND ITS TREATMENT. 

8. Chloral hydrate was used with most satisfactory 
results, especially in cases of collapse. 

9. Calomel, opium, and camphor in combination ; 
chloroform and chloral hydrate as stimulant. 

10. Quini sulph., tincture ferri chloride, tincture 
opii, and brandy gave satisfactory result. 

11. I£ Acidum sulphuricum 3 ss 

Morphia sulphas gr. -J 

Spt. vini gallici 3 iss 

Aqua dist t 3 iij 

The above solution was injected under the skin of the 
arms, legs, and over the stomach every hour until the 
symptoms were relieved. This has been done where 
there were all the prominent symptoms of cholera 
present. 

12. Internally, calomel, opium, capsicum, with 
stimulants. Externally, sinapisms, frictions, and heat. 

13. Calomel and opium in alternate doses, say in 
two of the former to one of the latter, repeated every 
hour for several hours. In conjunction with this> 
use the following : 

I£ Ext. cannabis indica gr. xvi 

Gum camphor 3 ss 

Chloroform 3 ss 

Mucilage acacia, 

Syrup simplex aa f ss 

Aqua cinnamoni f i 

A spoonful every one or two hours. 



TREATMENT. 83 

14. Creosote has been given with great success in 
cold stage of cholera. 

$ Creosote gtt. j 

Acpa camphora, 

Inf us. gentian can aa 3 vi 

One dose, and repeated every two hours. 

Dr. J. T. Jones also relies upon calomel, camphor, 
creosote, and ice in the treatment of cholera. 

15. Thirty or forty drops of laudanum, two grains 
of calomel, with one grain of camphor in early stages, 
and in collapse stage iced water and stimulant in large 
and repeated doses. 

16. Calomel and camphor in sufficient doses inter- 
nally; morphia hypodermically, often to be repeated. 
Dry heat to surface of the body and extremities. 

17. In three collapsed cases of cholera, the uses of 
calomel freely, and creosote and plumbi acet., were 
found of value as affecting the vomiting and purging ; 
chloroform was useful for cramps; opium, bismuth, 
tannin, and sulphuric acid were freely used. 

IS. Dr. D. O. Palin obtained good results from the 
use of veratria and dilute phosphoric acid. In acute 
stage the exhibition of calomel and opium were effica- 
cious. 

I can add numerous such prescriptions, but I think 
what I have given is enough to show the general plan 
of treatment adopted by the allopathic school. 

Here is a table showing the comparative view of the 



84 CHOLERA AKD ITS TREATMENT, 

various modes of treatment in cases of cholera in Eu- 
rope in 1832 and 1849: 

Mode of Treatment. Deaths. 

Tartar emetic 19 per cent. 

Salts and water 20 " 

Cold water and ice 30 " 

Ipecacuanha 57 ' ' 

Average «... 31 per cent. 

Calomel and opium 57 per cent. 

Opium alone 58 " 

Bleeding, calomel and opium 59 " 

Calomel alone. 62 " 

Stimulant 66 

Bleeding alone 85 " 

Injection into the veins 90 " 

Average 70 per cent. 

Homceopathic Treatment. — Comparative View of 
Homoeopathic and Allopathic Treatments. — Now I 
shall take up for consideration the treatment of cholera 
by the new system of medicine ; I mean the homoeo- 
pathic, that has gained so much reputation in the treat- 
ment of such cases. Cases of cholera have been treated 
homceopathically during the different epidemics with 
extremely satisfactory results. The comparative suc- 
cess of homoeopathic and allopathic methods of treat- 
ment in cases of cholera will be greatly in favor of the 
former. This will be evident if we look back to the 
statistical account of the homoeopathic treatment in 
cases of cholera. I should not like to go in detail into 
the discussion of this matter, as it would involve a great 



TREATMENT. 85 

controversy. I shall just state the fact, that on minute 
examination of the statistics, it will be observed that 
the death per cent in cases of homoeopathic treatment 
varies in different epidemics. In some the death per 
cent was very low, such as five or six per cent, though 
there are a few instances on record in which the treat- 
ment was so successful that there was not a single 
death; in others about eight or ten per cent, while 
others again fifteen per cent, though one authority 
states that the death rate in one epidemic w T as as high 
as thirty-nine per cent. Fifteen per cent is generally 
supposed to be the highest percentage of mortality 
under homoeopathic treatment. Even if we compare 
this highest with the average death-rate under allo- 
pathic treatment, we shall see that in every hundred 
we save about fifteen lives ; so if we consider for a 
moment the enormous number of deaths that take 
place in each cholera epidemic, we shall find we can 
save thousands and thousands of lives more if we fol- 
low the homoeopathic mode of treatment. If this 
method of treatment be carried out from the very be- 
ginning of a case, the result is almost always favorable. 
I presume to say that under the strict homoeopathic 
treatment cholera epidemic would not be a matter of 
horror, and the average percentage of mortality would 
not exceed any other epidemic disease. But there will 
be this much difference, the fear and dread of cholera 
might be just the same owing to the nature and 
rapidity of its fatal . termination, and also it attacks 
large numbers of people and spreads very fast. But 



86 CHOLERA ASTB ITS TREATMENT. 

on the whole it will be found that the percentage death- 
rate will be considerably lessened and will not exceed 
other epidemic diseases. By this I do not mean to say 
that cholera epidemic is no longer as dangerous because 
homoeopathic treatment will cure cholera ; for as a 
rule epidemics themselves are serious and dangerous 
and must be always apprehended. Such will be the 
case with cholera, and no less under the new system of 
treatment. Now this treatment, as I have mentioned, 
if followed from the very commencement almost 
always produces a most extraordinary result; at the 
same time neither the patient nor the attendants suffer 
so much from the development of distressing symp- 
toms, for they so smoothly subside by the internal 
administration of drugs in homoeopathic principle, 
which on the contrary would not respond at all to all 
the exertion of the attendants and the administration 
of the whole host of drugs of allopathic materia medica. 

For instance, when cramps break out simultaneously 
at dozen different parts of the body, we require half a 
dozen attendants to apply friction, or sometimes blister, 
which adds additional trouble to the patient. But 
under the new system of medicine we can do away 
with this ; in fact, no local application is required in the 
treatment of cholera. Without any further introduc- 
tion, I shall at once commence the consideration of the 
treatment. But before doing so I want to say a few 
words as regards the room in which our patient should 
be placed. 

Selection of a Boom. — The room for the patient 



TREATMENT. 87 

should be us much isolated as possible from the rest of 
the house. It should have windows for the free com- 
munication of fresh air from outside, and if practi- 
cable a second room near the former would do well for 
the attendants and unavoidable visitors. This saves un- 
necessary overcrowding around the bed of the patient, 
and also gossips and whispers of some kind or other. 
In the room there should not be more things than 
are absolutely necessary ; the carpets should be taken 
up, and also there should not be such things that cannot 
be easily disinfected if soiled with the evacuations. 
The temperature of the room must be moderately 
warm ; for this purpose in case of cold climate artificial 
means must be adopted ; steam w r ould answer best, but 
as this is not a plan that every one can afford, I think 
ordinary fire would serve our purpose. It must be re- 
membered that the temperature of the room should 
not be allowed to go down very low, neither too high. 
In cases of torrid zone I do not think they would re- 
quire any fire to heat their rooms, which are themselves 
sufficiently w r arm to answer our object ; but in excep- 
tional cases of severe winter, and in some places, though 
they geographically belong to that zone, in fact their 
nature-position, and other circumstances have made 
them equally cold to the frigid zone. In such places 
we would require artificial means to heat our rooms. 
Now, one single bed should be placed in the middle of 
the room for free ventilation and ready access on all 
sides, and the bed must be guarded by w^ater-proof. 
All discharges should be received in some vessel, either 



88 CHOLERA AND ITS TREATxMENT. 

chamber-pots or bedpans, etc., and these basins should 
contain some disinfectant substances. I think carbolic 
acid or powder, chloride or sulphate of zinc, chloride of 
lime or Condy's fluid will do nicely. If they contain 
some such material before the stools are passed, this 
deodorizes the discharge before it is diffused, and also 
it is thoroughly mixed up with the disinfectant. 
Nurses and other attendants should frequently cleanse 
their hands with disinfectant fluid, and they should be 
particularly careful not to' take any food without first 
carefully washing their hands. Sulphur may be 
burned in the room, but with some it is very unpleas- 
ant. 

Prophylactic Treatment : Medicinal. — I have al- 
ready spoken of the preventive treatment, but now a 
few words as to the medicinal prophylactic. 

Dr. Rubini says that during cholera epidemic three 
or four drops of the saturated tincture of camphor 
three times daily will act as a prophylactic. Smelling 
of camphor is supposed to act as a prophylactic. 

Dr. Raue says : " The best prophylactic is no doubt 
sulphur, as recommended by Dr. Hering in his ' Domes- 
tic Physician.' " 

First or sixth centesimal may be used for this pur- 
pose twice daily, in the morning and evening. 

Dr. Richard Epp says that the prophylactic homoeo- 
pathic remedies chiefly employed are cuprum and vera- 
trum album. They should be taken alternately during 
cholera epidemic, one each day ; a drop of the tinc- 
ture in a tablespoonful of cold boiled water every 



TREATMENT. 89 

morning and evening. Cuprum as a prophylactic has 
been recommended by many others. 

Treatment. — During the cholera epidemic slight in- 
disposition or tendency towards diarrhoea should be 
carefully noticed, and also proper means should be 
taken from the very commencement, without waiting 
to see what course it takes. The following drugs may 
be more or less used in cases of cholera : 

Ammonia, causticum, argentum nitricum, arseni- 
cum, asarum europgeum, belladonna, camphor, co- 
nium, cantharis, carbo vegetabilis, cuprum, hyoscy- 
amus, ipecacuanha, mercurius, nux vomica, opium, 
phosphoricum, acidum phosphoricum, acidum hydro- 
cvanicum, acidum nitricum, acidum sulphuricum, 
plumbum aceticum, rhus toxicodendron, secale, stramo- 
nium, sulphur, tartarus emeticus, croton tiglium, elate- 
rium, pulsatilla, lachesis, terebinthina, china, naja, 
jatropha, tabacum, ignatia, cicuta virosa, agnus castus, 
etc. 

The remedies that are used in the first stage, or, as 
it is sometimes called, choleraic diarrhoea, or cholerine, 
are not many ; in fact, for the treatment of cholera not 
many drugs are used. The patient should be put to 
bed at the very beginning, and be treated according to 
the indications. 

Camphor is supposed to be the best medicine 
in the early stage of cholera. Hahnemann strongly 
recommends the remedy, and it has been tried by 
several physicians in cases of cholera with great suc- 
cess. Dr. Drysdale of Liverpool and Dr. Russell of 



90 CHOLERA AND ITS TREATMENT. 

Edinburgh had great chances of trying this remedy in 
innumerable cases of cholera, especially in its early 
stage. Dr. Rubini of Naples and his colleagues 
treated five hundred and ninety-two cases of 
cholera during an epidemic with camphor alone, with- 
out a single death. So its marvellous effect in cases of 
cholera is undeniable and is admitted by both schools. 
Drs. Ringer and Wood, of the allopathic school, also 
recommend it in cases of cholera. Dr. Ringer says : 
" Few if any remedies are comparable to camphor in 
summer diarrhoea and cholera. Its benign influence 
in cholera is most conspicuous ; for it generally checks 
the vomiting and diarrhoea immediately, prevents 
cramp, and restores warmth to the extremities. It 
must be given at the very commencement and repeated 
frequently, otherwise it is useless. Four to six drops 
of strong spirits of camphor must be given every ten 
minutes till the symptoms abate, and hourly after- 
wards." 

Prof. T. F. Allen and others recommend the admin- 
istration of this drug, especially in cold stage of the 
disease. I believe this remedy can be freely admin- 
istered in the early as well as in collapse stages with 
great advantage, according to the circumstances of the 
cases. Now let us see what are the indications under 
which we may administer the drug in both stages. 

Indications for the Use of Camphor in the Early 
Stage. — Anxiety, restlessness, vertigo followed by 
nausea, headache, and heaviness of head; head hot, 
face red, with warmth of body ; burning thirst, and 



TREATMENT. 91 

drinks large quantity without relief ; nausea, vomit- 
ing, gulping up the contents of the stomach ; vomit 
bilious, mostly sour and watery ; sensation of heat in 
the stomach ; pain in the pit of the stomach, with 
fulness of the abdomen ; stool loose, with colicky pain 
or cutting pain ; urine scanty ; pulse quick and weak ; 
sensation of dryness all over the body. 

Indications for the Use of Camphor in Gold or Col- 
lapse Stage. — Delirium ; loss of memory ; a sense of 
coldness all over the head ; eyes fixed, staring, 
turned upwards and outwards ; or eyes closed at 
first, and later on staring, looking upwards ; pupils 
contracted, immovable ; lachrymation ; face wild, 
staring ; unconscious look ; pale, livid, cold sweat 
over the face, with vomiting ; pinched, deathly, and 
shrunken ; absence of nausea or vomiting ; body 
icy cold; coldness in the stomach, great prostration; 
absence of discharge ; retention of mine ; voice hoarse, 
husky ; breathing difficult, suffocating ; oppression ; 
cold face, limbs, and body ; pulse not perceptible ; 
diminished flow of blood in those parts away from 
the heart, with death-like paleness of the face. 

Administration of Camphor. — Dr. Rubini's tinc- 
ture of camphor is nine times as strong as the one in 
ordinary use, and twice as strong as that used by the 
homoeopathists. He gives four drops or even more — 
five to twenty drops — every five minutes, according to 
the severity of the case. I believe four or five drops 
for an adult every five minutes or so, in a small 



92 CHOLERA AND ITS TREATMENT. 

quantity of white sugar or on the tongue, should be 
given in early stage. In ordinary cases free perspira- 
tion breaks out in two to four hours, and cure is the 
result. However, if these early symptoms do not 
abate by its thus administration, we should rest assured 
it is not going to act, and we must resort to some other 
drugs. In cold stage the dose must be very much less 
and at longer interval. In cases of children drop 
doses will be enough, of course at the same interval. 

Before passing to the next stage, I shall just men- 
tion a few other remedies that may be indicated in 
this stage. 

Asarum Europcvum. — This may be given in the 
very early stage of the disease when there is stupid feel- 
ing in the head ; dull headache; dryness of the throat ; 
continuous nausea and inclination to vomit ; vomiting 
only a small quantity of greenish somewhat sour fluid ; 
empty eructation ; a sense of pressure in the stomach, 
rumbling and gargling in the abdomen, with violent 
colicky pain and sometimes vomiting ; stools semi-fluid, 
whitish gray, and not many in number. Pulse quick, 
breathing short ; great lassitude ; restless sleep ; some- 
times alternate feeling of burning and coldness. 

Dose : A drop of mother-tincture or 3d or 6th de- 
cimal in a wineglassful of water ; two teaspoonf uls 
should be given every two or three hours, according to 
the urgency of the case. 

Pulsatilla.— This remedy may be indicated espe- 
cially in the early stage, when the disease is brought on 
by eating fatty or oily substances too much. Bitter 



TREATMENT. 93 

taste in the mouth, or diminished taste for every kind 
of food ; nausea ; inclination to vomit ; thirst, dry mouth 
and throat ; a very little fluid causes inclination to vomit, 
especially at evening or night; loss of appetite; acid 
eructation, or sometimes putrid ; pain at the pit of the 
stomach ; this pain sometimes passes along the right 
hypochondriac region ; colicky pain in the abdomen, in- 
creased by motion ; rumbling of epigastrium ; stool 
watery, greenish and slimy, offensive ; pulse accelerated, 
small and weak ; vertigo especially when sitting ; ver- 
tigo when stooping ; sensation of heat in the head, and 
paleness of the face. 

Dose : Pulsatilla 6th, two to four drops or half 
a dozen pilules in a wineglassf ul of water ; two tea- 
spoonfuls every two hours or hourly. 

Phosphorus. — This will be indicated when the disease 
is ushered in by fatigue or exhaustion,such as comes from 
debauchery or licentious habit or too much sexual indul- 
gence. Depressed spirits, f earf ulness as if he is going to 
die ; irritability of temper ; easily excited ; vertigo, worse 
in the morning ; heaviness in the head ; nausea ; vomit- 
ing, worse in the morning; headache; noises in the 
ears ; eyes sunken, with blue ring around ; face pale and 
yellowish ; lips, mouth, and throat dry ; tongue tastes 
bitter, slimy, and dry ; thirst, and wants cold drinks ; 
regurgitation of food, with nausea ; sourish, offensive, 
large quantity of watery fluid ejected into the mouth ; 
constant nausea ; vomiting of bile ; heaviness in the 
stomach ; burning pain in the stomach ; loss of appe- 
tite ; inextinguishable thirst, not relieved by drink, 



94 CHOLERA AND ITS TREATMENT. 

rather gets worse ; cramps in the stomach radiating 
over the liver ; stools profuse, watery, and pouring as 
if from a hydrant, light-colored or greenish, with small 
white particles or sometimes undigested food ; much 
thirst for water, this increasing during the night ; there 
is little or no pain in passing stool ; urine gradually 
gets scanty and pale, turbid ; heart's action is acceler- 
ated, small, weak, and frequent. 

Phosphoric Acid will do as well under same cir- 
cumstances as have been stated above. This will do 
nicely when the patient is stronger built. 

Dose : Both phosphorus and phosphoric acid like 
Pulsatilla. 

Eujphorb. Cor. — This remedy may be indicated in 
some cases in this stage, especially when the vomited 
matter comes out with great force and the stools passed 
are like shot, and watery. There is troublesome feeling 
at the pit of the stomach, occasionally sinking, painful 
spasms of the intestines ; f aintness not uncommon : 
pulse slow and weak ; painful cramps of the hands and 
feet ; coldness of the extremities, as well as all over the 
body ; cold perspiration covers the whole body, and the 
patient feels weak as a rat, with death-like sensation and 
great anxiety. 

Dose like pulsatilla. 

Iris Versicolor. — This is a very good remedy in 
early stage of cholera. Dr. Hale and others speak 
highly of it. Dr. Hale says : "In cholera morbus I 
have succeeded in every case in which I have adminis- 
tered it, even the most violent. A single teaspoonful 



TREATMENT. 95 

of a few drops in half a tumbler of water, has in many 
severe cases put an immediate stop to the vomiting. I 
consider it a specific in this form of disease, and I would 
earnestly request physicians to try it in the first cases 
of cholera asiatica which may fall under their notice, 
and give the result to the profession. In cholera mor- 
bis it arrests the pain which is so violent in many cases 
at the pit of the stomach, or around the navel, or, in 
some cases, still lower down in the abdominal region, 
at or before every fit of vomiting or purging. In fact 
it seems, as far as I have as yet been able to judge, the 
more appropriate the more violent the pain, and in some 
cases acting, as the patients and bystanders express them- 
selves, 'like a charm.'" 

English homoeopathists have found iris very useful 
in cholera morbus, and even in true cholera. The 
special indications for its use are great burning distress 
in epigastrium ; it comes on every few minutes, and is 
so severe that the patient can hardly endure it; shocks 
of pain in the umbilical region up to the epigastrium, 
with nausea and belching of wind ; colicky pains about 
the navel before each spell of vomiting and purging ; 
thin, watery, copious discharges from the bowels, in a 
continuous stream ; and white tongue, severe headache, 
slight fever, hot sweat, and sense of despondency. 

Dose : A few drops (three or four) of the 1st or 3d 
in half a tumbler of water ; two teaspoonf uls every fif- 
teen minutes or half hour, or still longer interval, ac- 
cording to the urgenc}^. 

Aloes, bryonia, nux vomica, colocynth, podophyllum, 



96 CHOLERA A]STD ITS TREATMENT. 

ipecacuanha, and mercurius may be indicated in 
some instances. 

ISTow we pass on to the second stage, or the stage of 
evacuation or development. 

Cuprum. — "When there are cramps and vomiting, 
with all the other severe and troublesome symptoms 
of this stage, present, one of the best remedies is cu- 
prum. It unquestionably subsides the painful cramps, 
also exercises a great influence in arresting the vomit- 
ing. It is especially efficacious just at the onset of 
the collapse stage. 

Hahnemann considers this as the specific remedy 
for the " second stage of the clonic spasmodic charac- 
ter," and it has the power of cutting short the disease 
when camphor has failed. Drs. Russell and Drysdale 
speak very highly of it. They have found ample in- 
stances where it acted satisfactorily. In 1866, Mr. 
Proctor, who treated ninety-eight fully developed cases 
of cholera with this drug, found it answered fully well 
for cramps, though he lost fourteen out of ninety-eight 
cases. He writes : " For the cramps it was unquestion- 
ably the best remedy, and I may say for the vomiting 
also. In the stage of collapse I gradually found myself 
trusting to cuprum, and the impression is very strong 
on my mind that in collapse it is the most reliable of 
our remedies." 

Dr. Jousset gave it in the 12th dilution, and knew 
not a single failure, in cases of cramps of the 
calves. 

The indications for its use will be the development 



TREATMENT. 97 

of the following symptoms more or less pronounced : 
Great prostration with nervous excitability ; constant 
restlessness ; great weakness of muscles ; clonic spasms, 
beginning in the fingers and toes ; spasms and cramps 
in the calves ; drawing and dragging pain in the 
calf ; cramps in the abdomen ; violent spasms in the 
abdomen and upper and lower limbs, with keen dis- 
tressing screams ; stiffness of the whole body ; icy 
coldness of the feet and hands ; special senses become 
less acute ; eyes dim, lustreless, sunken, with blue ring 
around ; sense of hearing also diminished ; voice 
powerless, talking difficult; breathing quick, rattling, 
or short, panting ; difficulty of breathing ; pulse 
weak, thready, and compressible ; sometimes boring 
pain in the region of the heart ; the expression of 
the face sad, depressed ; pale, sunken features, pinched, 
and cold ; lips blue ; mouth dry or frothy ; tongue 
dry and rough ; papillae enlarged ; complete loss of 
appetite ; great thirst for cooling drink ; frequent 
nausea and constant vomiting ; vomit frothy, mucous, 
or bilious ; burning pain in the epigastric region ; 
rumbling in the stomach, with a sensation of pressure 
at the pit of the stomach ; stools profuse, gray, watery, 
with flocculent matter, and gushes out in stream ; 
urine scanty or entirely suppressed ; drowsy, with- 
out being able to sleep ; icy coldness of the body, and 
cold sweat at night. 

Dose : Dissolve five drops of the 3d or 6th dilution 
in a wineglassful of pure water, and give two tea- 
spoonfuls every fifteen, twenty, or thirty minutes, 
7 



98 CHOLERA AND ITS TREATMENT. 

according to the severity of symptoms. This repeti- 
tion of drug must be gradually at longer intervals as 
the severity of symptoms lessens. In cases of children 
the dose should be only one teaspoonful. 

Arsenite of Copper. — Dr. Hale found that this drug 
is very useful in some cases of cholera. He says : " I 
first used it in some seven cases of cholera which oc- 
curred in the years 1866 and 1867. These cases were 
marked by the usual intestinal disorder, to which were 
added severe and painful cramps in the abdomen and 
extremities. The alternation of arsenicum and cu- 
prum did not prove as satisfactory as I expected, but 
the use of cupric arsenite, in the sixth trituration, in 
water for children and dry on the tongue in adults, 
generally acted promptly. I can recommend it in 
cholera infantum, spasmodic and neuralgic pains in the 
bowels, accompanied by screams and cramps in the 
fingers and toes, attended with great debility and 
threatened collapse." The indications of the arsenite 
are those of arsenicum on one hand, that is, extreme 
prostration, etc., and those of cuprum on the other. 
I should prefer its administration when cupric symp- 
toms are more pronounced, as violent, colicky, cut- 
ting, drawing pains in the abdomen, neither increased 
nor decreased by pressure, and violent spasms in the 
abdomen, upper and lower limbs, especially cramps 
in the fingers, toes, and calves, causing the patient to 
scream. 

Dose : 3 X or 6 X trituration in water or dry on the 
tongue every half hour or hourly, according to the 
severity of the symptoms. 



TKEATMENT. 99 

Veratmtm Album. — Hahnemann has prescribed it 
for Asiatic cholera, and placed it among the best 
remedies for this disease. Subsequently the American 
and Russian practitioners have tried it in cases of 
cholera, and found that it acts satisfactorily in subdu- 
ing copious watery vomiting and purging, with cramps 
in the extremities, and severe spasmodic colicky pain. 
I think its administration will be most effectual when 
there is suppression of the first stage of the disease 
and the disease at once commences with the second 
stage and creeps quickly on to collapse stage. All 
the symptoms are very rapid in their development, as 
well as severe. Dr. Hughes says : " Tendency to 
copious diarrhoea and vomiting, with prostration, faint- 
ing, coldness, and cold sweating. It will benefit al- 
most every case, of whatever kind it may be." 

Indications for its use : Anxious, restless, extreme 
prostration ; inability to sit down, must lie down ; 
sudden sinking of strength ; vertigo ; heaviness of 
head ; faintness from least exertion ; sometimes head 
hot, and the head covered with cold sweat ; headache ; 
face pale, distorted; blue rings around the eyes; look 
wild ; nose more pointed and seems longer ; of leaden 
hue and cold ; eyes lustreless, lids livid, pupils con- 
tracted, and the patient fails to recognize near objects, 
or may do so but very slowly ; sometimes lachrymation 
and the pupils dilated; gradual deafness of ear; lips 
are bluish and quite dry ; grinding of the teeth ; tongue 
dry, withered, and cold ; may be coated, yellowish 
brown, and speech lisping, thick, and stammering ; 



100 CHOLERA AND ITS TREATMENT. 

mouth dry ; saliva very much lessened, or sometimes 
constant flow of saliva, like water-brash ; dryness of 

throat; bitter eructation ; hiccough ; nausea, with sen- 
sation of fainting and violent thirst ; thirst for cold 
drinks ; want everything cold ; drinks frequently, but 
only small quantity at a time, and the thirst is not re- 
lieved by drink ; violent vomiting, with continued 
nausea and great exhaustion ; vomited matters are 
bile-stained, yellowish green, foamy, sometimes contain 
undigested food ; painful retraction of abdomen during 
vomiting ; sensation of distress in the pit of the 
stomach ; pain in the epigastrium ; burning pain in 
the abdomen; cutting, colicky pain, with nausea and 
vomiting ; cold feeling and cold sweat in the abdomen ; 
stools are watery, mixed with flakes, prof use rice-water 
discharges gush out like stream with considerable force ; 
watery discharges are generally inodorous, green in 
color, and containing mucus, this being worse at night ; 
sometimes unconscious discharge of the f seces ; urine 
scanty and brownish or suppressed ; pulse frequent, 
small or slow, soft, intermittent ; circulation slower, al- 
most at a standstill ; coldness of the body all over ; 
cold, clammy perspiration ; distressing tonic cramps, 
commencing in the hands and feet and then gradually 
spreading all over the body ; respiration labored, and 
sometimes dyspnoea. 

Dose as for cuprum, and similarly repeated. 

Xanthoxylum. — This is a new remedy which has 
gained some reputation in the treatment of cholera. 
Dr. Hale says : " The most important clinical fact rel- 



TREATMENT. 101 

ative to the use of this medicine is its efficacy in chol- 
era/' 

" In Asiatic cholera," says King, " it was extensively 
used by many of the physicians in Cincinnati, and 
with great success. It acted like electricity, so sudden 
was its influence over the system; indeed, many patients 
likened it to an electric shock which seemed to diffuse 
itself through the whole frame. We gave it (the tinc- 
ture of the berries) in teaspoon Jul doses, slightly diluted 
and repeated, according to circumstances, every five, 
ten, or fifteen minutes." 

As regards the indications for its use nothing is par- 
ticularly known, but Dr. Hale says that it is his con- 
viction that the xanthoxylum acts in cholera in a man- 
ner quite similar to camphor and veratrum album. It 
seems to possess some of the properties of both drugs. 
It should be given when there are distressing cramps 
which resemble those of veratrum album, but have not 
subsided by its administration. And also it stimulates 
like camphor, hence may be tried in cold stage 
too. 

Dose : The tincture of the berries may be given in 
teaspoonful doses, often repeated. 

Croton Tigliuw,. — This remedy is most applicable in 
some cases when the stools are watery, yellowish, or 
watery mixed with whitish flakes and gush out like 
shot ; there is a burning sensation in the anus, and a 
feeling of oppression at the umbilical region down to 
the anus, with fulness and distension of abdomen : 
griping pain and also gurgling in the intestines, mostly 



102 CHOLEKA A2STD ITS TKEATME^T. 

on the left side. All these symptoms are aggravated 
by drink or food. 

Dose as for cuprum. 

Jatropha.— -Easy vomiting of a large quantity of 
whitish, jelly-like substances, resembling white of egg ; 
the contents of the rectum oaish out like a torrent, 
and gurgling noise in the abdomen ; anxiety, with 
burning pain at the pit of the stomach ; anguish, with 
coldness of the body ^ cold, sticky sweat; violent 
cramps in the calves of the legs ; pulseless, and great 
weakness. 

Dose like cuprum. 

Arsenicum Albitm is a very good remedy which 
greatly resembles veratrum album. The differences 
of indications between these two drugs are very few. 
In cases of arsenicum the symptoms are severe and 
develop rapidly. The special indications for this drug 
are: sudden and complete exhaustion; excessive, insati- 
able thirst, the patient, however, drinking only a small 
quantity at a time ; burning sensation at the anus long 
after stool ; tendency to pass into the stage of collapse 
quickly ; many inexpressible troubles on the part of the 
patient ; and the most characteristic distinction is that 
all discharges are scanty and excoriating. In some 
cases of arsenicum the patient may succumb after one 
or two evacuations. It also resembles, to some extent, 
camphor in the collapse stage. In veratrum album, on 
the contrary, there are excessive spasms, exhaustion in 
proportion to the vomiting and purging (in this drug 
the patient drinks a large quantity at a time), all dis- 



TREATMENT. 103 

charges are very profuse, and there is no excoria- 
tion. 

Indications : Confusion of head and weakness of 
memory ; intense anxiety, with restlessness, worse at 
midnight ; the patient cannot find rest anywhere ; con- 
stant tossing, change of place and feels extremely sad ; 
vertigo ; flickering before the eyes ; weakness of sight ; 
everything seems dim ; pupils contracted or dilated ; 
eyes sunken deep in the orbit, and blue margins 
around the eyes ; ringing in the ears ; the expression 
of the face anxious and distressing, pale, livid, bluish ; 
grinding of the teeth ; tongue dry and red, with papil- 
lae considerably raised from the surface, especially at 
the tip ; taste unpleasant, metallic, bitter or putrid ; 
dryness of mouth, with violent thirst ; throat also 
dry, and sensation of constriction, sometimes diffi- 
culty of swallowing and paralytic condition of the 
pharnyx and oesophagus ; loss of appetite, with ex- 
cessive thirst ; drinks often, but a little at a 
time, and the drinking does not refresh ; frequent hic- 
cup ; violent vomiting of food, this vomiting very 
much aggravated by eating or drinking anything ; 
vomited matter is green-yellow liquid, sometimes 
black ; pressure in the region of the stomach, and ten- 
derness of the stomach on pressure, and also intense 
heat and burning in the stomach and at the pit ; some- 
times it is so severe that it arrests the breathing ; 
rumbling in the bowels ; violent pain in the abdomen, 
with great anxiety ; pain about the navel ; purging, 
with extreme coldness of the extremities ; the stools are 



104 CHOLERA AND ITS TREATMENT. 

slimy, green, mucous, black like dirty water, sometimes 
very offensive ; urine scanty, sometimes a profuse dis- 
charge, turbid ; retention of urine, threatening to urae- 
mia ; voice weak, hollow, hoarse, or loss of voice ; res- 
piration short, and difficulty of breathing ; pulse accel- 
erated, quick and small, rapid, very frequently irreg- 
ular, thread-like, and often quite imperceptible at the 
wrists; external coldness, with cold, clammy sweat ; 
cramps in the calves ; twitching of the muscles ; ex- 
haustion from slightest exertion ; the fingers and the 
toes are shrivelled, the nails and lips are blue; great 
emaciation; the muscles are relaxed and flabby; sleep- 
lessness, with restlessness and moaning, and frequently 
startings during the sleep. All these symptoms are 
more marked at night. 

Dose : One drop of the first or sixth dilution in a table- 
spoonful of pure water, every one, two, or three hours. 
Repeat at a longer interval as the symptoms get better. 

Tabacum. — Nausea and vomiting if persistent after 
purging yielded, recurring in constant paroxysms with 
cold sweat ; anguish and restlessness ; emaciation and 
death-like pallor of the face, blue and pinched ; great 
thirst ; oppression in the stomach ; nausea, worse on 
the least motion ; spasm in the calves ; icy coldness of 
the extremities ; body might be warm or cold ; cramps 
in the arms and hands. This remedy follows veratrum 
well. It is often indicated in collapse stage. 

Dose same as arsenic. 

Antimomum Tartaricum. — In some instances this 
drug may be indicated, especially when the irritation 



TREATMENT. 105 

of the intestinal canal is caused by some undigested 
food, and when there is congestion of the brain, giving 
rise to nervous symptoms. Indications for its use : 
Confusion of head ; mental excitement ; vertigo; head- 
ache, heaviness of head, with a great feeling of pressure 
extending downward into the left eye; painful sensa- 
tion in the head, especially when moved ; flickering be- 
fore the eyes; dimness of vision ; eyes tired, and incli- 
nation to close the lids tightly together ; roaring in the 
ears ; face pale, sunken, bluish ; cold sweat on the face ; 
sweat on the forehead and head ; twitching of the 
muscles of the face ; tongue reddish, dry, or thinly 
coated ; taste bitter, sour ; mouth sore, much thirst ; 
drinks little and often ; appetite lost ; violent hiccup ; 
empty eructation ; nausea, vomiting ; vomit watery, 
mucous, green, sometimes undigested food ; after 
vomit great exhaustion ; a sensation of overloading in 
the stomach ; violent pain in the epigastrium ; spas- 
modic pain in the stomach, same feeling in the abdo- 
men, as if stuffed ; violent colicky pain in the abdomen, 
especially around the umbilicus, with rumbling in the 
bowels ; stools are watery and profuse, either yellowish 
or greenish ; urine scanty ; both the upper and lower 
extremities cold ; the tips of the fingers and toes are 
wrinkled and dry, sometimes without sensation. 

Dose same as arsenic. 

Ipecacuanha. — When the other symptoms of this 
stage are not so marked, this remedy may be used with 
the following indications: constant nausea; vomiting 
of bile, of sour fluid, or of a dark-colored liquid ; great 
thirst after vomiting ; violent distressing pain in the 



106 CHOLERA AHD ITS TREATMENT. 

pit of the stomach ; indescribable sick feeling in the 
stomach ; griping and intensely sharp pain in the in- 
testines, aggravated by movement. 

Dose : One drop of the first or sixth dilution in an 
ounce of water, two spoonfuls every half-hour or 
hourly. 

Generally these above remedies check the further 
progress of the disease ; but in cases where still the 
worst symptoms are persistent we will keep on admin- 
istering most of the remedies that we have used in the 
second stage, according to their indications. For in 
the early part of the third stage they will answer per- 
fectly well, such as cuprum, arsenic, veratrum ; but if 
still the disease creeps on towards worse and collapse 
sets in, we have to administer some other remedies 
according to their indications. 

Camphor is a very good remedy for this stage, and 
I have given its indications for use in this stage (p. 91). 

Aconite. — When the hands and feet are icy cold, 
and in fact icy coldness all over the body ; cold, 
clammy perspiration here and there ; general appear- 
ance bluish-looking ; face pale ; pupils contracted at first 
and then tendency to dilatation ; roaring in the ears ; 
mouth quite dry, and the tongue and lips are also dry ; 
swallowing almost difficult ; excessive, unquenchable 
thirst ; hiccup ; now and again scanty, loose, slimy 
or mucous stools and slight vomiting ; gradual dis- 
tension of the abdomen, with a feeling of uneasi- 
ness ; voice has nearly suppressed ; respiration labored, 
with oppression in the chest ; pulse hardly percep- 



TREATMENT. 107 

tible and heart's action very slow — under these cir- 
cumstances this remedy may be given to establish 
proper circulation and respiration, and thereby to raise 
the general temperature of the body and set a reaction. 

Two cases in which there was a state of collapse, 
subjective and objective coldness, excessive thirst but 
inability to retain anything on the stomach, restless- 
ness, two drops of tincture of aconite in half a 
tumbler of water, of this two teaspoonfuls as a dose, 
revived the patient at once, and convalescence was 
established. (C. W. Boyce, N. Y. St. Tr. p. 520.) 

Dose : One or two drops of the tincture in six 
dessert-spoonfuls of water, two spoonfuls every fifteen 
minutes or half -hour, or still longer interval, according 
to circumstances. 

Hyoscyamus. — This remedy will be well indicated 
when there is paralysis of the sphincter and unconscious 
passage of the feces, half in bed and the other half re- 
tained in the rectrum, due to the inability of its musc- 
ular coat ; the abdomen becomes distended and tympa- 
nitic, the muscles painful and integument slightly 
sensitive, and a feeling of oppression in the stomach 
and abdomen ; there may be involuntary copious dis- 
charge or suppression of urine, generally the latter ; 
stools are scanty ; loss of senses ; both hearing and sight 
are greatly impaired ; delirious and slight unconscious- 
ness; eyes look without lustre, and constant staring at 
surrounding objects, or sometimes eyelids are nearly 
closed ; does not reply to questions, or does not recog- 
nize any one ; body cold and pale all over ; face blu- 



108 CHOLERA AND ITS TREATMENT. 

ish ; throat dry and parched ; difficulty to swallow li- 
quids ; respiration labored and slow ; tongue dry, hard, 
looks like leather ; heart's action slow ; pulse at the 
wrist scarcely perceptible — if any, small, weak, and ir- 
regular. 

Dose like aconite ; or, l x or 3 s may be given. 

Carbo Vegetabilis. — This drug is often indicated 
for this stage, especially in some cases where there is 
stoppage of vomiting and purging, but occasional pas- 
sage of stools ; the stools are terribly offensive, putrid 
or smell cadaverous, and passed involuntarily, might 
contain pus, generally light-colored or yellow or pale, 
thin, frothy, mucous ; gradual distension of abdomen ; 
tympanitis ; urine quite suppressed. Besides these the 
patient is pulseless, the face and limbs are cold, breath- 
ing short, breath cold, cold sweat here and there, vital 
forces nearly exhausted, and the patient lies as if 
dead. 

Dose : A drop of third or sixth potency, or still higher, 
in a dessert-spoonful of water every ten, fifteen, or 
thirty minutes. Arsenic acts very well with carbo ve- 
getabilis in this stage when given one or two doses as 
an intercurrent. 

Acidum Ilydrocyanicum. — This is considered one 
of the best remedies known for this stage. Dr. Sircar, 
who had a vast experience in India, speaks very highly 
of this drug. " Hydrocyanic acid," he says, "is use- 
ful, in fact is the only remedy when, along with pulse- 
lessness, the respiration is slow, deep, gasping, or diffi- 
cult and spasmodic, taking place at long intervals, the 



TREATMENT. 109 

patient appearing dead in the intermediate time. If 
any remedy is entitled to be spoken of as a charm, it 
is this. It would seem at times to restore animation 
to a corpse." It has been highly praised by several 
other practitioners, who found the same satisfactory 
result from its use in this stage. 

Indications for its use principally are the follow- 
ing : The general appearance of the body is death- 
like ; there is no sign of animation in any part of the 
body except the gasping breath, which is slow, deep, 
and spasmodic in character; there might be snoring 
and frequent tendency to arrest the breath ; the vital 
forces are nearly at a standstill ; heart beats slowly ; 
no pulsation at the wrists, or in some cases even at the 
brachial or carotid arteries ; the general paleness of the 
skin all over, with a blue tinge, and icy coldness ; the 
pupils are dilated, wide open, immovable, and insensi- 
ble to light; sight obscured; there is thin, scanty, 
sometimes continuous passage of stool ; urine is quite 
suppressed. In fact, the patient is threatened with 
death every moment. 

Dose : One drop of the first in a dessert-spoonful 
of pure water every fifteen or twenty minutes. 

Secale Cornufoim. — This remedy may be used with 
great success in this stage, when there is persistent 
tonic or clonic spasm which has not been subdued by 
the administration of cuprum. Indications : Eyes 
sunken, surrounded by blue lines ; dilated pupils, 
nearly immovable ; confusion of hearing ; stools scanty, 
offensive, slimy or watery, discharge involuntary, but 



110 CHOLERA AND ITS TREATMENT. 

comes out with force ; painless paralysis of the rectum ; 
spasmodic distortion of the mouth and lips; dry 
tongue; sometimes spasm of the tongue, also spas- 
modic jerks of the hands, with flexion of the hands at 
the wrists, or of the forearms ; fingers drawn in to- 
ward the palm ; cramps in the calves, and the toes spas- 
modically drawn up towards the dorsum of the foot ; 
in fact, painful contraction of all the flexor muscles ; 
difficulty of breathing ; respiration slow and labored ; 
heart's action slow ; pulse suppressed. This is espe- 
cially useful in cases where there is extreme coldness 
of the body, with a sensation of heat on the part of the 
patient : he cannot bear any covering, and if any such 
thing be put on his body he throws it back and ex- 
presses signs of great anxiety. Depending mostly 
on this symptom, of course also w r ith other graver 
symptoms of bad prognosis, Prof. Allen states that he 
treated an old lady, aged about eighty, of true Asiatic 
cholera, with thirtieth potency of this drug, with her 
• complete recovery. 

Dose : A drop of the first in two dessert-spoonfuls 
of water. Give two teaspoonfuls every fifteen minutes, 
or so, until the cramps subside. 

Lachesis. — When the breathing becomes gasping, 
slow, and intermittent, and the life is threatened with 
asphyxia, with all other symptoms of this stage. 

Dose : A drop of third dilution in an ounce of 
pure water, two teaspoonfuls every five or ten minutes. 

JVaja. — This remedy may be also given when the life 
of the patient is threatened with asphyxia, either due to 



TREATMENT. Ill 

extreme exhaustion or impediment of pulmonary circu- 
lation by emboli. The most characteristic subjective 
symptom dyspnoea ; this distressing struggle for breath 
is most agonizing. 

Dose : This may be given in third trituration every 
fifteen minutes or so. 

Crotalus Horridits. — This remedy has been strongly 
recommended by Professor S. P. Burdick, who tried 
it in several severe cases of cholera in late epidemics 
with great success. The special indication for its use 
is the distressing pain around the navel, with all other 
typhoid symptoms. Dose like JSTaja. 

Cantharis. — -This remedy is especially useful in cases 
of suppression and retention of urine, with or without 
delirium, convulsion, or coma. It is useful during the 
reaction stage when all other severe symptoms have 
abated and there is delay in the appearance of urinary 
secretion, with frequent desire to urinate-. 

Dose : One drop of the first or third dilution in a 
tablespoonful of pure water every hour. 

Terebiniha. — This drug is occasionally called for 
when cantharis has failed to produce urinary secretion. 

Dose as cantharis. 

Kali Bichro. may be sometimes used under the 
above circumstances. Dr. Hughes recommends this 
drug in cases of incontinence of urine in cholera. 

When there is troublesome hiccups the following 
remedies may be given : 

Agnus Castus. — When there is hiccup, nausea, and 
occasional vomiting. 



112 CHOLERA AND ITS TREATMENT. 

Dose: One or two drops of the sixth, twelfth, or 
thirtieth dilution in a tablespoonful of pure water 
every one, two, or three hours. 

Cicuta Yirosa. — Violent hiccup, with spasm in the 
pectoral muscles ; distortion of the eyes ; difficulty of 
breathing, or convulsions. 

Dose like agnus. 

Ignatia. — Hiccup after eating and drinking, with 
gulping up of a bitter fluid or undigested food ; nausea. 

Dose like agnus. 

Phosphorus. — Violent hiccup immediately after the 
meals. 

Dose like agnus. 

Belladonna. — -Hiccup with half -suppressed eructa- 
tion, especially useful in reaction stage. 

Dose like agnus. 

Pulsatilla. — Paroxysmal hiccups during sleep, after 
drinking, accompanied with sour eructation. 

Dose like agnus. 

Besides, carbo veg., sulphur, staphysagria, rata, 
moschus, nux vomica, etc., are often indicated for 
hiccup. 

In some cases sleeplessness becomes a troublesome 
symptom. The following medicines may be indicated 
for this purpose : 

Belladonna. — Sleep is prevented by great anxiety ; 
the patient feels sleepy but cannot sleep ; congestion 
of the blood-vessels of the conjunctiva ; the pupils are 
dilated ; sometimes dreams, and a feeling of uneasiness 
in the morning connected with disturbed sleep. 



TREATMENT. 113 

Dose : One or two drops of the sixth, twelfth, or 
thirtieth dilution in a tablespoonful of pure water, 
twice or thrice daily, or still oftener. 

Chamomilla. — Restless at night, with eyes half open ; 
cannot sleep, though the patient feels sleepy and tosses 
about. 

Dose like belladonna. 

Coffea. — When there is great excitement, due to 
which the patient cannot sleep. 

Dose like belladonna. But higher dilutions act 
better. 

Hyoscyamus. — Sleeplessness, with excessive irrita- 
bility ; constant slumber ; the patient falls asleep and 
wakes up in a minute ; stupid and drowsy looking. 

Dose like belladonna. 

Besides, kali carb.,nux vomica, opium, rhus, arsenic, 
etc., may be used. 

China is a very good remedy in quiet convalescence, 
when the patient complains of great weakness ; vertigo ; 
ringing in the ears ; pale face ; loss of appetite , with 
or without diarrhoea ; tongue coated white ; taste bit- 
ter. 

Dose : One drop of the first, sixth, or thirtieth 
potency in a tablespoonful of pure water every three 
or four hours. 

Phosphorus. — In reaction stage when all other symp- 
toms have abated, but brownish discharge from the 
bowels continues for too long a period, then this rem- 
edy may be given to moderate the discharge. 

Dose : One drop of the third, twelfth, or thirtieth, 



114 CHOLERA AND ITS TREATMENT. 

potency in a tablespoonful of water after every evac- 
uation. 

Phosphoric acid may be given with same indications 
as phosphorus, and in the same dose. Here the pros- 
tration is less than phosphorus. 

Podophyllum. — Yellow-colored fetid discharge > 
painless, watery ; or the faeces may be covered with 
mucus ; worse in the morning. 

Dose: A drop of the sixth, twelfth, or thirtieth 
potency in a tablespoonful of water four times in a 
day. 

Nux Vomica. — Diarrhoea alternate with constipation ;, 
tympanitis ; small, scanty mucus stool, and a feeling 
of dissatisfaction after evacuation. 

Dose like podophyllum. 

Mercurius. — When stools contain mucus or blood ; 
clay-colored and offensive, due to defective secretion of 
the liver : though its action on the liver is doubtful, for 
Prof. T. F. Allen says that mercurius has no action on 
the liver. 

Dose like podophyllum. 

Nitric Acid. — Stools scanty, with tenesmus ; may 
contain mucus or blood ; putrid ; taste bitter after 
eating, and cadaverous smell from the mouth. 

Dose like podophyllum. 

Sulphuric Acid. — Painless diarrhoea, with great de- 
bility ; sour eructation and a sense of weakness all over 
the body ; yellow-colored stools. 

Dose like podophyllum. 

Besides, sulphur, aloes, argent nitr., arsenicum, 



TREATMENT. 115 

benzoic acid, carbo veg., colocynth, croton tig., 
gelseminum, kali carb., lycopodium, rhus tox., 
veratrum al., etc., may be indicated. 

Sometimes our attention may be called to compli- 
cated cases of fever during convalescence. 

Aconite. — Burning heat, especially in the head and 
face; pain in the limbs; shivering over the limbs, 
chiefly in the evening after lying down ; redness of 
cheek ; cannot bear to be covered during the hot stage ; 
dry, burning skin, with excessive thirst ; pulse hard, 
strong, and accelerated ; tongue white ; great anxiety. 

Dose : One or two drops of the 6th, 12th, or 30th 
potency, in* a tablespoonful of pure water, every two 
or three hours. 

Belladonna. — Congestion of blood in the head, with 
coldness of extremities ; worse in the evening or at 
night, and fever commencing with rigors ; little or no 
thirst ; headache ; burning in the stomach ; dimness of 
sight ; pupils dilated ; delirium ; sweat generally begins 
on the face ; sleeplessness ; pulse quick and strong ; 
there may be loss of consciousness. These symptoms 
are more or less connected with brain trouble. 

Dose same as aconite. 

Eupatorium Perfoliatum. — This is a very good rem- 
edy when the fever is connected with the gastro-hepatic 
system. Thirst several hours before the chill and con- 
tinues after it; aching and soreness in the back and 
limbs; constant nausea, retching, and vomiting of 
bile ; violent colicky pain in the abdomen, with throb- 
bing headache, especially occipital ; tongue white or 



116 CHOLERA AND ITS TREATMENT. 

yellowish ; taste bitter. There may be morning diar- 
rhoea or constipation. 

Dose same as aconite. 

But when the fever is complicated with disorder 
of the stomach, arsenic, nux vomica, and bryonia are 
indicated; when the source of the trouble lies in the 
small intestine, mercury and bryonia ; the liver, bryonia, 
nux vomica, podophyllum ; the colon, mercury, nux, 
ipecac, and carbo veg. ; and when lungs are complicated, 
bryonia and phosphorus, etc. 

In the treatment of the typhoid state of cholera the 
following remedies are usually indicated j opium, 
hyoscyamus, rhus tox, stramonium, zincuili, cuprum ; 
lachesis, arsenic, carbo veg., etc. 

Opium. — Unconsciousness ; stupor ; can scarcely be 
roused ; speechless or loud talking ; mild delirium ; 
staring look ; the pupils are dilated or contracted, and 
insensible to light. Dryness of the lips, mouth, and 
throat ; may be involuntary discharge of large quantity 
of urine or retention of urine; breathing rattling, ster- 
torous, or snoring in character, with wide-open mouth. 
Pulse imperceptible; convulsive movement of the 
limbs ; constipation or involuntary offensive watery 
stools. 

Dose : One drop of the 6th, 12th, or 30th potency in 
a tablespoonful of water every fifteen minutes, thirty 
minutes, or hourly. 

Hyoscyamus. — Stupor ; loss of consciousness ; can- 
not recognize any one ; does not answer questions 
when asked ; restless, and tries to get out of bed; red 



TREATMENT. 117 

face, and red, sparkling eyes ; pupils dilated ; constant 
staring at surrounding objects, and sometimes rolling of 
the eyeballs in the orbits ; stools involuntary ; urine 
scanty, and passed involuntarily ; trembling of the 
arms and hands; sleeplessness, or constant sleep with 
muttering ; coma vigil ; pulse small, weak, scarcely 
perceptible. 
. Dose like opium. 

Rhus Tox. — Restless sleep ; constant restlessness, 
tossing about ; absence of mind ; forgetf ulness ; deli- 
rium ; talks much to himself ; answers correctly but 
slowly ; tongue and mouth dry, with much thirst ; ab- 
domen bloated ; involuntary discharge of cadaverous- 
smelling mucous stools, especially at night ; heart's ac- 
tion very feeble. 

Dose like opium. 

Stramonium. — Loss of consciousness ; hallucinations ; 
strange, absurd ideas ; singing ; laughing ; eyes wide 
open, staring ; pupils dilated, immovable, and insensible 
to light ; spasmodic distortion of the face ; grinding of 
the teeth ; loss of speech and hearing ; face pale ; foul, 
smelling stools ; absence of urinary secretion, or once 
in a while profuse involuntary discharge of urine; 
breathing short and difficult. 

Dose like opium. 

Bryonia. — Eush of blood to the head ; confusion of 
head ; headache worse by the slightest motion ; irrita- 
bility of temper ; dryness of tongue, mouth and lips, 
without any thirst or sometimes with thirst, relieved 
by drink ; distention of the stomach and wind eructa- 



118 CHOLERA AND ITS TREATMENT. 

tion ; tenderness in the epigastrium ; rumbling and 
gurgling in the bowels ; great sensitiveness of the ab- 
domen ; sleeplessness on account of uneasiness ; night 
restless, disturbed by frightful dreams. 

Dose like opium. 

Zincum. — Unconsciousness ; weak memory ; twitch- 
ing of the muscles ; staring eyes ; delirium ; attempt to 
get up in bed ; small, frequent pulse, scarcely per- 
ceptible ; tongue dry; does not want to talk; scanty, 
involuntary stools. 

Dose like opium. 

Lachesis. — Complete insensibility ; weakness of 
memory ; muttering, delirium, especially at night ; 
redness of the eyes, with ulceration of the cornea ; can- 
not bear light at all ; thin, offensive stools ; restless 
sleep, with many dreams, or persistent sleeplessness ; 
impaired sensibility of touch in the distal extremities, 
with the commencement of gangrene. 

Dose like opium. 

Cuprum, arsenic, carbo veg., and other drugs that 
are used in typhoid fever may be indicated. 

For the uremic symptoms the following remedies 
may be advantageously administered : opium, hydro- 
cyanic acid, hyoscyamus, arsenic, cuprum; and Boehr 
says lactuca virosa, agaricus, anacardium, etc., may be 
used. 

Ojpiumk&s been recommended by Boehr and Hughes 
in cases of uraemia; vertigo; loss of consciousness; 
delirious; pupils dilated, insensible to light; violent 
roaring in the ears, deafness ; cold sweat on the fore- 



TREATMENT. 119 

head ; dryness of the tongue, mouth, and throat ; nau- 
sea and vomiting, or sometimes purging ; complete 
suppression of urine ; respiration slow and stertorous ; 
great drowsiness ; can hardly keep awake ; sometimes 
snoring, with eyes half open. 

Dose : One drop or two of the 6th, 12th, or 30th 
potency in a tablespoonful of water every fifteen, 
twenty, or thirty minutes, or at a still longer interval. 

Hydrocyanic Acid. — Giddiness ; oppressive pain in 
the head ; loss of sight or dimness ; great prostration ; 
nausea ; sometimes vomiting of black fluid ; face pale, 
and the general surface looks bluish ; respiration slow, 
deep, and frequent arrest of breath ; diminished action 
of the heart, gradually approaching to paralysis. 

Dose like opium. 

Hyoscyamus. — Delirious ; picking at the bedclothes ; 
vertigo ; confusion of ideas ; stupor ; loss of sight or 
smell ; pupils dilated ; dryness of the tongue, mouth, 
lips, and fauces ; retching and vomiting ; sometimes 
involuntary stools ; suppression of urine. 

Dose like opium. 

In the ulceration of the cornea local medicines and 
proper bandaging are of the greatest importance. In- 
ternal remedies. 

Cinchona. — In the early stage ; great prostration ; 
dimness and weakness of sight ; cannot bear strong 
light ; intermittent pain ; and there is ringing in the 
ears. 

Dose : One or two drops of the 6th or 30th potency 
in a tablespoonful of water every two or three hours. 



120 CHOLERA AND ITS TREATMENT. 

Calcarea Garb. — Opacity of the cornea; profuse 
lachrymation ; commencement of ulceration ; slight or 
no pain ; sensitiveness to light ; photophobia. 

Dose like cinchona. 

Arsenicum. — Feeling of sand in the eyes ; burn- 
ing ; weakness of sight ; sensitive to light ; photopho- 
bia ; trembling of upper lid, with lachrymation. 

Dose like cinchona. 

Gonium. — Superficial ulceration, with photophobia 
and lachrymation. The ulcerations are non-inflam- 
matory in character. 

Dose like cinchona. 

Graphites. — Superficial or deep ulcerations, with pro- 
fuse lachrymation and photophobia ; this lachrymation 
increases in the open air ; burning and aching pain in 
the eyes ; intolerance of light. 

Dose like cinchona. 

Hepar Sulph. — Ulcers on the cornea ; aching pain 
from daylight, and also when moved ; sight becomes 
dim ; a feeling of pressure as from sand. 

Dose like cinchona. 

Aurum, argentum nitr., mercurius, sulphur, phos- 
phorus, euphrasia, lycopodium, apis, pulsatilla, carbo 
veg., etc., may be indicated. 

In cases of gangrene, arsenicum, china, crotalus, 
lachesis, secale cor., silicea, etc., should be given. 

Arsenicum. — Insensibility of the distal parts, with 
slight swelling and pain ; breaking out of reddish spots 
or bluish blisters ; dryness of the body, etc. 

Dose : One or two drops of the 6th or 30th potency 



TREATMENT. 121 

in a tablespoonful of water, every three or four 
hours. 

China. — When there is great debility, coldness of 
the whole body, particularly the extremities; there 
may be vomiting and hiccup. 

Dose like arsenic. 

Crotahis. — Painful numbness of the toes; gangrene 
more general ; insensibility of the swollen part ; the 
swollen part is cold, and painful to pressure. Pulse 
imperceptible. 

Dose like arsenic. 

Carbo Veg. is used when there is general gangrene. 

Lachesis is used when the gangrene has far ad- 
vanced. So is secale cor. 

In cases of boils and carbuncles, Professor Helmuth 
says that berberis vulgaris is an excellent medicine 
to hasten suppuration in boils, and its proper adminis- 
tration removes the predisposition to them. 

The medicines that are used for boils are arnica, bel- 
ladonna, calc, hep., mercurius, nitric acid, thuja, etc. 

The medicines for carbuncles generally used are 
arsenicum, belladonna, hyoscyamus, china, rhus tox, 
muriatic acid, etc. 

Arsenicum. — When there is great prostration, 
emaciation, vomiting, burning thirst ; pulse small, irre- 
gular, and frequent, and the carbuncle more of a diffu- 
sive character. 

Dose : One or two drops of the 6th or 30th po- 
tency in a tablespoonful of water every three or four 
hours. 



122 CHOLEKA AND ITS TBEATMEOT. 

Belladonna. — When the brain symptoms are more 
pronounced, with a tendency to spread rapidly. 

Dose like arsenic. 

Rhus Tox. — When there is extreme painful sensa- 
tion around the seat of carbuncle, with pale face, 
stupor, convulsions. 

Dose like arsenic. 

Hyoscyamus is useful in nervous persons ; muriatic 
acid in scorbutic and china in asthenic character of the 
disease. 

XY. Diet. 

In the diarrhoeal stage the food should be 
easily digestible and nutritious. No coffee, tea, or 
fermented liquors. Barley-water, lemonade, or iced 
water may be given in moderation as a drink. A little 
arrow-root, milk, beef-tea, or chicken broth may be 
given before the commencement of the vomiting, for 
when this symptom commences there is no use of 
giving any sort of diet, though this may be tried, but 
it seems to me quite ineffectual. But when the disease 
has fully developed, cold-water drink and sucking of 
ice will greatly relieve the excessive thirst, so this 
may be given freely. In the stage of reaction particu- 
lar care should be taken in diet ; any mismanagement 
of diet would give rise to troublesome symptoms. 
Extract or essence of beef, beef-tea, mutton or veal 
broth or chicken broth, and by and by eggs and 
toasted bread, etc., may be given. A little brandy or 



METHOD OF PREPARING SOME OF THE DIETS. 123 

port wine and egg mixtures will do in some cases 
nicely. No vegetables, unripe fruits, or sour fruits 
or pastry, should be given. When the reaction has 
established, soup, chicken and rice, or fowl and rice, 
provided that it is not highly seasoned, should be 
given. Light puddings, as rice pudding, baked bread 
pudding, boiled custard pudding, and stewed fruits, 
calf's-foot jolly, bread jelly, or port-wine jelly, may be 
given. 

THE METHOD OF PREPARING SOME OF THE ABOYE DIETS. 

1. Essence of Beef . — Take one pound of juicy beef, 
free from fat and skin ; chop, it up very fine, add a 
little salt, and put it into an earthen jar with a lid ; 
cement the edges of the cover with a thick paste, and 
place the jar in the oven for three or four hours. 
Strain off the liquid essence through a coarse sieve, 
and give the patient one or two teaspoonfuls at a time. 

2. Extract of Beef . — Take one pound of fresh beef, 
free from fat, mince it thoroughly, and add a pint of 
cold water. Place it in a pot at the side of the fire to 
heat very slowly. It may stand two or three hours 
before it is allowed to simmer, and then let it boil 
gently for fifteen minutes. Either you may skim or 
strain off the liquid extract ; and then give the patient 
one or two teaspoonfuls at a time. 

3. Beef Tea. — 1. Take one pound of beef, without 
fat, mince it fine and put it into a common earthen 
pot, with a pint and a half of cold water. Stand the 



124 CHOLERA AND ITS TREATMENT. 

pot on the hob, so that it may simmer for three or 
four hours. Strain, and give the patient two or three 
teaspoonfuls or more at a time. 

Another way of preparing : 

2. Take two pounds of beef, without fat or bone, 
put it in a jar with two or three ounces of cold water, 
and place the jar in a saucepan of water. Simmer for 
four hours, and so on. 

4. Mutton or Veal Broth. — Take of mutton or veal 
two pounds, cold water two pints, a little salt and pep- 
per, and one or two ounces of rice. Simmer three or 
four hours and boil for a few minutes ; strain, and re- 
move all the fat before serving. 

In cases of chicken, take half a chicken (about a 
pound and a half), with the bone well broken. 

5. Eggs and Brandy. — Beat up three or four eggs 
to a froth in four or five ounces of spring water, add 
two or three lumps of sugar, and pour two or three 
ounces of brandy, stirring all the time. A portion of 
it must be given at a time. 

6. Port Wine and ^^.-^-Beat up an egg with a 
fork till it froths, add a lump of sugar and two spoon- 
fuls of water, mix up thoroughly well, pour in a wine- 
glassful of port wine, and serve. 

7. Chicken and Bice. — Cut up the meat of chicken, 
some rice, put a little salt, pepper, and some water, 
and get them well cooked. 

Another way : 

Cut up the meat of boiled chicken. Have ready 
some rice well cooked and seasoned with salt, put 



METHOD OF PREPARING SOME OF THE DIETS. 125 

round a small flat dish, warm up the chicken in a little 
good gravy, and serve in the middle of the dish with 
the rice round it. 

8. Mice Pudding. — One ounce of rice, twelve 
ounces of milk, half an ounce of butter, one egg, and 
a little sugar. Let the rice swell in the milk over a 
slow fire, stir in butter, and then let the mixture cool. 
Well beat the egg, and mix with the rice. Butter a 
cup, fill it three parts full, and bake. 

9. Baked Bread Pudding, — Half a tumbler of fresh 
milk, a quarter of a pound of bread crumbs, two eggs, 
one ounce of butter, a little sugar. 

Boil the milk, pour it over the bread crumbs, and 
let them soak for half an hour. Beat the eggs, mix 
them with the bread crumbs and the sugar and butter, 
and stir well till thoroughly mixed. Butter a small 
pudding mould, fill it half full with the mixture, and 
bake in a gentle fire for about twenty minutes. 

10. Boiled Custard Pudding. — Beat two eggs, pour 
half a pint of warm milk to them, stirring all the 
while. Butter a small basin that will exactly hold it, 
put in the custard, and tie a floured cloth over it ; 
plunge it into boiling water, float it about for a few 
minutes, boil it slow T ly for half an hour. 

11. Bread Jelly. — Take a quantity of the soft part 
of a loaf, and cover it with boiling water and allow it 
to soak for some hours. Then to be strained off com- 
pletely and fresh water added. Place the mixture on 
the fire, and allow it to boil for some time until it be- 
comes smooth ; the water is to be pressed out, and the 



126 CHOLERA AND ITS TREATMENT. 

bread on cooling will form a thick jelly. This can be 
used with sugar and milk. 

12. Port Wine Jelly, — Put into a jar one pint of 
port wine, two ounces of gum arabic, isinglass (gela- 
tine), and sugar, a quarter of a nutmeg grated fine, and 
a small piece of cinnamon. Let this stand closely 
covered all night. The next day put the jar into boil- 
ing water, and let it simmer till all is dissolved, then 
strain it, let it stand cold, and then cut it up into small 
pieces for use. 

A short table showing the death per cent under the 
homoeopathic treatment : 

Name of the Place. No. of Cases. Death. Rate per cent. 

Vienna 581 49 8 

Vienna 998 95 &£ 

Prague in Moravia, etc.. 1,269 85 6f 

In Kussia and Austria . . 2,753 264 9^ 

Russia 1,270 108 8* 



IKDEX. 



MEDICINAL PROPHYLACTIC. 

PAGE 

Camphor 88 

Cuprum 88 

Sulphur 88 

Veratrum al 88 

REMEDIES IN THE EARLY 
STAGE. 

Asarum Europasum 92 

Camphor 89 

Euphorbium cor 94 

Iris versicolor 94 

Phosphorus — .. 93 

Phosphoric acid 94 

Pulsatilla 92 

Aloes 95 

Bryonia 95 

Colocynth 95 

Ipecacuanha 96 

Mercurius 96 

Nux vomica 95 

Podophyllum 95 

REMEDIES IN THE SECOND 
STAGE. 

Arsenicum al 102 

Antimonium tartaricum 104 

Croton tig 101 

Cuprum 96 

Cuprum arseniosum 98 

Ipecacuanha 105 

Jatropha 102 

Tabacum 104 

Veratrum al 99 

Xanthoxylum 100 

REMEDIES IN COLLAPSE. 

Aconite 106 

Arsenicum al 106 

Camphor 91, 106 

Carbo veg 108 

Crotalus horridus Ill 

Cuprum 106 

Hydrocyanic acid 108 

Hyoscyamus 107 



PAGE 

Lachesis 110 

Naja 110 

Secale cor. 109 

Veratrum al 106 

FOR SUPPRESSION OF URINE. 

Cantharis Ill 

Kalibich Ill 

Terebintha Ill 

REMEDIES FOR TROUBLESOME 
HICCOUGH. 

Agnus castus Ill 

Belladonna 112 

Cicuta virosa 112 

Ignatia 112 

Phosphorus 112 

Pulsatilla 112 

Carbo veg 112 

Moschus 112 

Nux vomica 112 

Ruta ... 112 

Staphysagria 112 

Sulphur, etc , 112 

REMEDIES FOR SLEEPLESS- 
NESS. 

Belladonna 112 

Chamomilla 113 

Coffea 113 

Hyoscyamus 113 

Arsenicum 113 

Kali carb J 13 

Nux vomica 113 

Opium 113 

Rhus tox, etc 113 

REMEDIES IN REACTION STAGE, 
WITH SLIGHT DIARRHCEA. 

China 113 

Mercurius 114 

Nitric acid 114 

Nux vomica 114 

Phosphorus 113 

Phosphoric acid 114 



128 



INDEX. 



PAGE 

Podophyllum 114 

Sulphuric acid 114 

Aloes 114 

Argen. nitr 114 

Arsenicum 114 

Benzoic acid 115 

Carbo veg 115 

Colocynth 115 

Croton tig 115 

Gelseminum 115 

Kali carb 115 

Lycopodium 115 

Rhus tox 115 

Sulphur 114 

Veratrum al., etc 115 

FOR FEVER. 

Aconite 115 

Belladonna 115 

Eupatorium per, etc 115 

REMEDIES FOR TYPHOID STATE 
OF CHOLERA. 

Bryonia 117 

Hyoscyamus 116 

Lachesis 118 

Opium 116 

Rhus tox 117 

Stramonium 117 

Zincum 118 

Arsenicum 118 

Carbo veg 118 

Cuprum 118 

REMEDIES FOR UREMIC SYMP- 
TOMS. 

Hydrocyanic acid 119 

Hyoscyamus 119 

Opium 118 

Agaricus 118 

Anacardium 118 

Arsenicum 118 

Cuprum 118 

Lactuca virosa 118 

FOR ULCERATION OF THE 
CORNEA. 

Arsenicum 120 

Calc. carb.... 120 

Cinchona 119 



PAGE 

Conium 120 

Graphites 120 

Hepar sulph 120 

Arum 120 

Argen. nitr 120 

Apis ... 120 

Carbo veg 120 

Euphrasia 120 

Lycopodium 120 

Mercurius 120 

Phosphorus 120 

Pulsatilla 120 

Sulphur, etc 120 

FOR GANGRENE. 

Arsenicum 120 

Carbo veg 121 

China 121 

Crotalus 121 

Lachesis 121 

Secale cor 121 

FOR BOILS AND CARBUNCLES. 

Arsenicum 121 

Belladonna 122 

Berberis vul 121 

Hyoscyamus 122 

Rhus tox 122 

Arnica 121 

Calc 121 

Hepar 121 

Mercurius 121 

Nitric acid 121 

Thuja 121 

DIET FOR CONVALESCENTS. 

Baked bread-pudding 125 

Beef -tea 123 

Boiled custard-pudding 125 

Bread-jelly 125 

Chicken and rice 124 

Eggs and brandy 124 

Essence of beef 123 

Extract of beef 123 

Mutton-broth 124 

Port-wine and eggs 124 

Port-wine jelly 126 

Rice-pudding 125 

Veal-broth 124 



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